Signage on the outside of the corporate headquarters building of health insurance company Anthem is shown in Indianapolis in May 2019. Credit: Michael Conroy / AP

Mainers with health insurance through Anthem Blue Cross and Blue Shield will no longer be able to receive in-network coverage at Maine Medical Center in Portland beginning in 2023, MaineHealth announced Wednesday.

The change will take effect on Jan. 1, 2023. MaineHealth’s other facilities will continue to accept Anthem.

MaineHealth officials said providing coverage through Anthem had become untenable, with a shortfall in payments causing concern about the hospital’s ability to continue to serve patients. The insurer owes MaineHealth more than $70 million for services over the last three years. Anthem has also been withholding payments totaling around $13 million a year, officials said.

“This is an existential issue for us,” Andrew Mueller, CEO of MaineHealth, said Wednesday. “If we don’t somehow get through this, this puts our ability to deliver services to our communities in jeopardy.”

Anthem is among the most widely used health insurance companies in Maine. The lifting of in-network coverage by Maine’s largest hospital will affect the coverage of many Mainers including state employees who are insured through Anthem.

Anthem Blue Cross and Blue Shield of Maine said in a statement that it had sustained a strong relationship with MaineHealth for several years. But it cited concerns with the provider during the last few years about “unilateral increases” in charges at Maine Medical Center.

That resulted in higher costs for patients using Anthem as well as other health insurers, Stephanie DuBois, a regional spokesperson for the insurer, said in a statement. Those higher rates were unacceptable, she said.

“It’s disappointing MaineHealth would choose to alarm consumers by announcing an intention to leave our care provider network when our current contract doesn’t expire for another two years,” DuBois said.

Anthem remained committed to resolving issues with MaineHealth, DuBois said. Asked if Mainers insured with Anthem will face higher out-of-pocket costs at Maine Medical Center in 2023, DuBois said there was still plenty of time before the end of the year to negotiate.

Anthem withheld around $13 million a year in previously negotiated payment rates beginning last August because it seemed to believe it was entitled to funds MaineHealth received from a federal program intended to reduce the costs of drugs for hospitals, Mueller said.

That decision soured an already difficult relationship. Mueller had “no idea” why Anthem thought that money was theirs. He said Anthem had not explicitly cited that as the reason for withholding payments but MaineHealth officials had determined it was likely the reason for the insurer’s demands.

Maine Medical Center dropping Anthem was an unprecedented event in Maine’s recent medical history, said Maine Hospital Association President Steven Michaud.

“I’ve been around since the ‘80s and I’ve not seen it happen,” Michaud said. “It’s often threatened because of contract negotiations and all that. But this is a first.”

Yet, he wasn’t surprised about Wednesday’s decision. Hospitals across Maine have had major problems with Anthem for some time, he said.

A December survey from the Maine Hospital Association found that Anthem owed association members $350 million in outstanding debts. The survey also found that Anthem had denied claims that shouldn’t have been rejected and repeatedly asked for medical records for the same claim.

“The fact that Maine Med did this tells you just how bad it must be,” Michaud said. “You avoid this as much as you possibly can because it impacts individuals and businesses so much.”

Michaud said other Maine hospitals could also drop Anthem following Maine Medical Center’s announcement as the “frustration” about the company was statewide and even nationwide. However, he cautioned that he had not heard of other hospitals planning to do so thus far.

While Mueller believed that the decision would likely drive Mainers to other local hospitals, “none of that matters” if Maine Medical Center couldn’t survive, he said.

Mueller said he was hopeful that Anthem customers would get treatment at other MaineHealth hospitals in the Portland area, including Southern Maine Health Care Medical Center in Biddeford and Mid Coast Hospital in Brunswick.

The shift will affect people who receive Anthem through their employer as well as those who buy insurance directly through Anthem, including through the Affordable Care Act exchange.

MaineHealth had informed state officials about the decision before Wednesday. Mueller said he couldn’t speak to whether MaineHealth’s decision will affect the insurance plans offered to state employees, who are presently insured by Anthem.

As of 2019, Anthem was listed as the largest insurer in Maine with 131,237 insured — a 69 percent market share, according to data from the Kaiser Family Foundation.

The decision doesn’t completely shut off those with Anthem from using Maine Medical though.

Mainers with Anthem can continue to receive treatment at Maine Medical Center. However, that care will be considered out-of-network and thus may be more costly. Out-of-network care generally requires higher out-of-pocket costs than in-network coverage. Many Americans avoid receiving health coverage out of their network to avoid unnecessary expenses.  

Emergency care at Maine Medical will still be considered in-network for Anthem customers. The hospital will also continue to provide in-network care for Anthem patients treated through physicians and other providers within MaineHealth Medical Group.

Mueller did not rule out a future agreement with Anthem, but said patients should have the expectation that the change will take place on Jan. 1.

MaineHealth was making the announcement now because it wanted to give patients and employers who offer Anthem advanced notice, Mueller said. That’s also why it was not cutting off Anthem at its facilities besides Maine Medical Center.

MaineHealth will also drop Anthem as the health plan administrator for MaineHealth employees beginning on Jan. 1, 2023. It has not chosen a new provider, Mueller said.

The impact of Anthem’s lack of payments on MaineHealth was further exacerbated by new costs in the health care industry, including a workforce shortage that has shot up temporary labor costs, Mueller said. Medical equipment has also become more expensive.

This is not the first time Anthem has faced backlash from hospitals due to its practices. Last week, the state of Georgia fined the company $5 million after officials said Anthem misled patients about what hospitals and providers were available through its network.

Georgia’s insurance commissioner said he had been inundated by complaints from hospitals and doctors about Anthem since his “first day in office” in 2019. The company owes hospitals and doctors across the U.S. billions of dollars, according to officials in several states.

Suzanne Spruce, a spokesperson for Brewer-based Northern Light Health, said that it had experienced delays with Anthem, including for out-of-state and Medicare Advantage claims. The health care network meets monthly with Anthem to review “outstanding issues,” Spruce said.