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Maine Medical Center terminating contract with Anthem in 2023

Maine Medical Center is the biggest hospital in Maine and Anthem is the largest insurer in the state
Published: Apr. 7, 2022 at 8:33 AM EDT
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PORTLAND, Maine (WABI) - – Maine Medical Center announcing it will no longer participate as an in-network provider of non-emergency care for Anthem’s commercial subscribers starting on January 1st. 2023.

MaineHealth, the parents company of Maine Medical Center, releasing a statement Thursday morning. “Even though Anthem subscribers will have nine months to prepare, we know that this will affect many of our patients, and we deeply regret having to take this step,” said Andrew Mueller, MD, CEO of MaineHealth. “We will do everything in our power to reduce the impact of this change on our patients, however our relationship with Anthem has reached a point where it is hurting our ability to sustain the level of care our communities have come to expect from MaineHealth and its flagship hospital, Maine Medical Center.”

The statement goes on to say that the decision to pull MMC out of the Anthem network is “based on how the insurer’s practices in recent years have impacted MMC and its patients. Anthem owes MaineHealth in excess of $70 million for health care services dating back over three years. Anthem has also been reducing negotiated payments to MMC that should not be in dispute.

As has been reported in the news in recent months, Anthem has been struggling with making payments on time to many health care providers across Maine, including MMC, blaming system errors for the problem. Anthem also has been denying prior authorizations and referrals for needed care, forcing patients and their physicians to appeal or resubmit claims. Last summer, Anthem denied proper reimbursement to in-network providers because it was using incorrect provider identification numbers. As a result, Anthem incorrectly denied claims for 10,000 MaineHealth accounts.

While the insurer has said publicly that it is fixing its systems and putting its problems behind it, that has not been the experience of MaineHealth. Last week, the Georgia Office of Insurance and Fire Safety fined Anthem $5 million for practices similar to what MaineHealth has experienced.”

Anthem is a publically traded, for-profit company. They released a statement saying, “We’ve had a strong working relationship with Maine Health for many years, but for the last few years we’ve been in discussions with them regarding unilateral increases in charges for health services provided at Maine Medical Center. This has resulted in direct higher costs to our members and all consumers that use maine medical center, which is unacceptable”

“We would not pull Maine Medical Center out of Anthem’s network unless we felt we absolutely had to,” said Mueller in the statement from MaineHealth. “We have been in discussions, including mediation, with Anthem for several months and have made little progress. While we want to work productively with all our partners, we have to prioritize our ability to deliver the high level care our communities depend on us to provide. This is especially true when we are navigating through a global pandemic and its aftermath, which has placed tremendous strain on our caregivers and our resources.”

MaineHealth said it only plans to remove MMC from the Anthem network because the insurer has been focused on MMC. MaineHealth also hopes that confining the change to MMC will minimize the impact on patients covered by Anthem and any disruption in its service area of 11 counties in Maine and Carroll County, N.H.

Leaving the Anthem network would not necessarily prevent patients covered by Anthem from using MMC, but insurers typically do not cover care obtained from out-of-network providers at the same level as those that are in-network. Patients often have to pay more out-of-pocket to use a provider out of an insurer’s network. Under the law, Anthem must continue to fully cover emergency care at MMC even without an in-network agreement. And MaineHealth is committed to do what it can to reduce the impact that this change will have to patients covered by Anthem.

Governor Janet Mills also releasing a statement expressing her concern about the contrat termination. “I am deeply concerned about the potential for a contract termination between MaineHealth and Anthem. Maine Medical Center is the largest tertiary care hospital in Maine and Anthem is the state’s largest insurer, serving more than 300,000 people, including State employees. Termination of the contract would significantly harm the cost of and access to care for Maine people who are Anthem customers, particularly in southern Maine, and seriously impact the operation of the health care market across the state. Termination should be avoided at all costs. As both private parties negotiate the contract, I strongly urge them to put the interests of Maine people first, to resolve this issue in a timely way, and to reach an agreement that averts the need for such a drastic, damaging move.”

For subscribers to Anthem|MaineHealth Medicare Advantage plans, MaineHealth has advised Anthem that it intends for MMC to continue to remain in the Anthem network for those. Also, MaineHealth has no plans to remove its physicians and other providers in its system-wide medical group from the Anthem network, nor, as noted above, any hospital other than MMC. MaineHealth has also notified Anthem that the insurer will no longer be the third-party administrator of MaineHealth’s self-funded health insurance plans for its employees beginning in 2023.

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