Despite a plea from Gov. Janet Mills to avoid a split, Maine’s largest hospital still plans to take the state’s largest insurer out of its network in the new year.
On April 6, MaineHealth announced that Mainers with Anthem Blue Cross and Blue Shield would no longer be able to receive in-network coverage at Maine Medical Center in Portland beginning in 2023. That decision drew outcry from Mills, who said it was a “drastic, damaging move” that should be reversed.
But in MaineHealth’s first extensive comments since that announcement, health system officials said Wednesday that they stand behind their decision to drop Anthem and highlighted the damage inflicted by Anthem’s practices in Maine and nationwide.
Tap above for answers to your FAQ about Maine Medical Center’s split from Anthem Insurance. Navigate by tapping the right side of your screen. Press the gray “x” in the upper left corner to exit the story.
“There has been no indication from Anthem that it is prepared to change its business practices in a way that would cause MaineHealth to reconsider its decision,” the statement said.
Earlier this month, MaineHealth CEO Andrew Mueller called the split from Anthem, which will not affect any other MaineHealth facilities, an “existential” decision — indicating that the health system may not be able to survive if Maine Med continued to take Anthem patients in-network.
The insurer owes MaineHealth more than $70 million for services over the last three years and has also been withholding payments totaling around $13 million a year, Mueller said.
But Anthem has responded to MaineHealth’s decision with allegations of its own. Company spokesperson Stephanie DuBois said that Maine Medical Center has been overcharging patients for years, an “unacceptable” practice.
In Wednesday’s statement, MaineHealth leadership said Anthem had used billing details taken out of context to create a misleading picture of the hospital’s charging policies.
It noted that Anthem spokespeople had used the same tactic in disputes elsewhere. That statement also referenced a decision last week by a federal arbitrator that Anthem’s practice of denying or downgrading reimbursement claims on ER visits was unlawful and breached its contract with 11 Indiana hospitals. Anthem was ordered to pay the hospitals $4.5 million.
MaineHealth and Anthem have been negotiating through a mediator since the April 7 announcement. However, little appears to have changed since then.
Patients who go to an out-of-network hospital tend to pay higher out-of-pocket fees. MaineHealth’s statement said it had not received any information from Anthem about what its plans were for Anthem patients at Maine Medical Center in 2023 despite a formal request.