On Wednesday, Maine Medical Center in Portland announced it would no longer provide in-network coverage to patients insured with Anthem Blue Cross and Blue Shield of Maine beginning in January 2023.
Gov. Janet Mills said it was a “drastic, damaging move.” Maine Hospital Association President Steven Michaud called it essentially unprecedented in Maine’s recent history.
Maine Medical’s decision could affect medical coverage for hundreds of thousands of people across Maine for years to come.
We asked Bangor Daily News readers what questions they had about the split. Here are the answers.
Will emergency treatment at Maine Medical Center still be covered in-network if you are insured with Anthem?
Yes – emergency care is not affected by this announcement.
What other care at Maine Medical Center will continue to be covered in-network?
If you are a subscriber to an Anthem/MaineHealth Medicare Advantage plan, you will continue to be covered. If your physician or provider is in the MaineHealth Medical Group, you will also continue to be covered in-network when receiving services.
MaineHealth has advised those with questions about how their individual plans will be affected to call Anthem’s member services number on the back of their insurance card.
While Maine Medical Center will no longer cover Anthem patients in-network, other MaineHealth hospitals and facilities will continue to do so.
When will Maine Medical Center stop providing in-network coverage to Anthem customers?
MaineHealth CEO Andrew Mueller said Wednesday that Maine Medical Center would stop providing in-network treatment to Anthem customers on Jan. 1, 2023, a bit less than nine months from now. Mueller said he was making the announcement early so that employers and individuals with Anthem have time to make decisions on their insurance.
Does this mean those insured with Anthem will have to pay higher out-of-pocket costs for care at Maine Medical Center beginning on Jan. 1?
It’s unclear, but likely. The primary advantage of in-network care is usually its lower cost, with many Americans avoiding care from providers that don’t take their insurance in-network due to unnecessary expenses.
When an Anthem spokesperson was asked about this Wednesday, she didn’t respond directly but said there was a long way to go before January 2023 and that she was hopeful MaineHealth would work with Anthem to resolve their disputes.
Why did MaineHealth drop Anthem from in-network coverage?
Though there are other elements to the decision, it came down to unpaid debts and withheld payments: MaineHealth said Anthem owes it $70 million for services over the last three years in addition to around $13 million in withheld payments each year.
CEO Andrew Mueller said staying with Anthem could disrupt its operations across Maine. He called the issue “existential,” saying that MaineHealth may not be able to survive if it continued under the current conditions with Anthem.
Why is MaineHealth dropping Anthem coverage from Maine Medical Center but not other MaineHealth locations?
MaineHealth officials say they wanted to minimize disruptions for Anthem customers while severing the relationship that has brought the most problems.
What does in-network coverage mean?
In-network coverage generally means coverage where an insurer and provider have a contract with one another that usually corresponds with fewer out-of-pocket costs for the insuree.
In this case, MaineHealth has been on contract to provide certain medical care at Maine Medical Center that Anthem provides reimbursement for on behalf of patients with its coverage.
How has Anthem responded to MaineHealth’s announcement?
Anthem has been very critical of MaineHealth’s decision, accusing MaineHealth of overcharging Maine Medical Center patients through a regional spokesperson. Those statements did not directly address the funds that MaineHealth says Anthem owes.
Who does Maine Medical Center serve?
Maine Medical Center primarily serves the around 540,000 people in the Portland metro area. However, Mainers outside the Portland area also go to the hospital frequently, especially for specialized care. It also gets some patients from out-of-state, including New Hampshire, where it’s the closest tertiary care hospital in some regions.
How many people in Maine are insured through Anthem?
More than 300,000 Mainers have insurance through Anthem in Maine, a number that makes up more than one-fifth of Maine’s total population, according to a statement from Mills. Notably, Maine state employees also receive their health insurance through Anthem.
An Anthem spokesperson said it insured around 323,000 in Maine, including those with programs coordinated with the federal government like Medicare.
What is Anthem?
Anthem, Inc. is an Indianapolis-based for-profit health insurance provider within the Blue Cross Blue Shield Association. It conducts its Maine operations under Anthem Blue Cross and Blue Shield of Maine.
How will this impact other health providers in the state?
It remains to be seen, but it will likely spur traffic spikes for other hospitals in the Portland area beginning next year if no agreement between Anthem and MaineHealth is reached by then.
MaineHealth CEO Andrew Mueller acknowledged as much on Wednesday, but said he hopes those insured with Anthem opt to go to other MaineHealth hospitals that will continue to take Anthem, like Mid Coast Hospital in Brunswick and Southern Maine Health Care in Biddeford.
There are more than a half dozen other hospitals in the Portland metro: they are listed below by closeness to Maine Medical Center.
— Northern Light Mercy Hospital (Portland – 2 miles)
— Southern Maine Health Care – Biddeford (Biddeford – 19 miles)
— Mid Coast Hospital (Brunswick – 32 miles)
— Southern Maine Health Care – Sanford (Sanford- 33 miles)
— Bridgton Hospital (Bridgton – 39 miles)
— York Hospital (York – 45 miles)
The nearest tertiary care center to Maine Medical Center is Central Maine Medical Center in Lewiston, about 37 miles away. Without significant traffic, a drive between the two hospitals takes around 50 minutes.
Could other Maine hospitals cut ties with Anthem?
It’s possible. While none have announced similar decisions, Maine Medical is far from the only hospital having problems with Anthem. A December survey by the Maine Hospital Association of its members found Anthem owed around $350 million in outstanding debts, according to association president Steven Michaud.
That survey also found that Anthem had denied claims that shouldn’t have been rejected and repeatedly asked for medical records for the same claim.
Michaud said there was “frustration” about Anthem in hospitals across Maine and the country. He said that other Maine hospitals could follow Maine Medical Center in dropping in-network coverage, but hadn’t heard of any planning to do so as of Wednesday.