A man walks toward the main entrance at St. Joseph Hospital in Bangor the morning of April 22, 2020. Credit: Natalie Williams / BDN

On the eve of their deadline for a new contract, a Catholic health care system with hospitals in Maine and a major insurer have not reached an agreement, which for months has left about 14,000 patients in limbo.

The contract between Covenant Health, a family of Catholic health care organizations in New England and part of Pennsylvania, and insurer Anthem Blue Cross and Blue Shield expires Tuesday. As of Monday, differences had not been resolved, according to the insurer.

Starting Wednesday, Covenant Health’s physicians, such as those at St. Joseph Healthcare in Bangor and St. Mary’s Health System in Lewiston, will leave the insurer’s network, said Stephanie DuBois, spokesperson for Anthem Blue Cross and Blue Shield in Maine.

Failure to settle the dispute means Maine patients will face hard decisions. There are about 14,000 whose access to services is at risk.

A patient wishing to stick with their longtime family medicine doctor, for instance, will likely see an increase in co-payments and other costs. Some cannot afford the increases, so they’ll be forced to find new providers and health care facilities, or they may decide to switch insurance companies. 

Anthem has encouraged its members to schedule appointments with other providers in their area, including Northern Light Health facilities in Bangor and Central Maine Healthcare facilities in Lewiston. In its latest update, the insurer warned that costs “can go up dramatically” if Covenant leaves its network.

There are exceptions for Anthem members with complex conditions who are receiving care at Covenant Health facilities, DuBois said. Patients who are pregnant or terminally ill, among others, can apply to continue care at a location where their doctor is no longer in the insurer’s network, though this is for a limited time, typically 90 days, she said.

The contract expiration will have no effect on emergency care, according to both companies.

In a statement released about 5:30 p.m. Monday, Covenant Health wrote to patients it was disappointed to not have come to a resolution with Anthem ahead of the contract expiration, and it is likely that the insurer will remove from its network Covenant’s 225 affiliated providers in Bangor and Lewiston.

“This is not the outcome that we wanted or anticipated when we began conversations with Anthem Maine last October,” read the statement, provided by spokesperson Karen Sullivan, noting it does not reflect hours of negotiations and compromises offered.

In its June 1 update, Covenant Health claimed that it was a low-cost, high-quality provider in Maine asking Anthem to pay it consistent with market rates paid to other facilities and providers for similar services.

Anthem has extended offers to Covenant Health to keep the company in its network, including increases in line with current and historical inflation, but those were refused, DuBois said.

Covenant Health “continues to insist on double-digit rate increases that are more than three times the rate of inflation,” she said, which would place a burden on Maine employers and members.

Sullivan disputed the claim, saying that Covenant Health has asked Anthem to “increase our rates by a modest percentage in recognition of overwhelming increases in workforce costs and inflationary pressures.”

Covenant Health wrote in an earlier update that it was disappointed with the terms and rates that Anthem has offered, pointing out that the insurer’s parent company, Elevance Health, reported a first quarter profit of nearly $2 billion this year.

Anthem advised patients with questions to call the member services phone number on the back of their ID card. Covenant Health directed them to the Maine Bureau of Insurance website. Patients with questions specific to their circumstances should call 207-907-1682 in Bangor or 207-753-4995 in Lewiston.