The dispute between Anthem Blue Cross and Maine Medical Center through which Maine’s largest hospital threatened to withdraw from the network of the state’s largest insurer was unusual for many reasons. The main one, though, was that its sudden resolution this week did not require a higher entity to settle their differences.
Anthem and Maine Medical Center said this week that the Portland hospital would remain in the insurer’s network for two more years, through the end of 2024. The announcement came after the hospital made its impasse with the insurer public in April, announcing that it would no longer be part of Anthem’s coverage network starting Jan. 1, 2023.
While disputes between insurers and health care entities are not uncommon, the majority are solved behind closed doors. When they do reach the public sphere, it is usually because they involve a violation that catches regulators’ attention.
For instance, Anthem was hit with a $5 million fine from regulators after its list of health care providers was inaccurate in Georgia. In that same state, a county judge had to require coverage to continue while a hospital there and Anthem battled over contract negotiations. A Virginia hospital accused Anthem of violating the state’s timely payment laws.
Here, Maine Medical Center said in April that Anthem owed it more than $70 million for services over the past three years. Anthem in turn said MaineHealth, the hospital’s parent organization, was overcharging for services. The stakes were high, and political leaders including Gov. Janet Mills urged a swift resolution.
Whether the two entities resolved their differences is unknown. After announcing a new two-year agreement on Wednesday, neither hospital nor the insurer released details. MaineHealth on Friday declined to respond to further questions about the deal and referred a reporter to a Wednesday press release announcing the agreement with Anthem.
The very public nature of MaineHealth and Anthem’s contract fight set it apart from the get-go, as did the tactics. MaineHealth drew attention to other Anthem battles in April, such as when an arbitrator in Indiana ruled against the insurer in a dispute with 11 hospitals there. It accused the insurer of misconstruing billing practices to the media.
“In its disputes across the country, Anthem has used this complexity to make unsupported claims about overcharging,” MaineHealth said in an April 20 news release.
Anthem hit back, using its advocacy group to promote a petition asking MaineHealth to stop overcharging for services and accusing it of worrying customers unnecessarily.
Colin Manning, a spokesperson for Anthem, said coming to a quick resolution was key once the dispute went public. He also pushed back against comparing the MaineHealth dispute to problems in other states, saying the circumstances and regulations were different.
“When this matter went public it was important that we were timely and transparent with our customers and members to ensure them we were working on their behalf to provide better outcomes and to protect health care affordability,” he said.
The MaineHealth-Anthem dispute set the stage for other frustrated health care entities to go public: Fore River Urology in Portland, an independent practice, ended its contract with the insurer in August. Coastal Women’s Healthcare in Scarborough also threatened to terminate its contract with Anthem earlier this summer, although the two entities have since reached an agreement.
Peter Hayes, the CEO and president of the Healthcare Purchaser Alliance of Maine, whose members include employers that buy health insurance, said how the dispute played out in public will be a case study for health care transparency issues down the line. While either side could present their grievances, he pointed to recent federal regulations that require transparency in health care costs and resources that show the pricing information of many hospitals.
Those requirements could not only help consumers make sense of their financial choices, but shed light on how Anthem and MaineHealth’s agreement will affect customers in the end, even if the agreement details are not readily available.
“I’m sure they’ll become known,” he said. “In Maine, nothing stays a secret long.”