Contract talks have stalled between Northern Light Health and Anthem.
That comes three years after another high-profile fight between Anthem, Maine’s largest health insurer, and MaineHealth, the state’s largest health system, which includes hospitals in Portland and Belfast.
On Wednesday afternoon, Northern Light Health said its contract with Anthem will expire on Sept. 30, 2025, if the insurer doesn’t agree to raise reimbursement rates.
That would mean Northern Light’s hospitals from Presque Isle to Bangor to Ellsworth would move out of network for Mainers with Anthem insurance.
James Rohrbaugh, executive vice president and chief financial officer for Northern Light Health, said Wednesday that Anthem’s reimbursement rates have increased at a rate of less than 1.5 percent despite the annual inflation rate for health services averaging 7.5 percent. Reimbursement for services is necessary to keep hospitals, practices and services open and staffed, Northern Light said.
“Anthem’s unwillingness to keep pace with the costs of providing care directly contribute to the risks facing rural healthcare,” James Rohrbaugh said in a statement.
Additionally, Northern Light Health pointed to Anthem’s increase in payment denials for patient care and its 10 percent increase in its profit margin in Maine.
“Anthem Blue Cross and Blue Shield and Northern Light Health are currently in discussions to continue member access to affordable care at Northern Light’s doctor’s offices and hospitals beyond December 30, 2025,” Anthem spokesperson Matt Wheeler said in a Wednesday afternoon statement.
“Unfortunately, Northern Light’s statements referencing September 30 are misleading. Our current contract runs through that date, however it includes a minimum 90-day extension to allow both parties continued negotiation time to avoid member care disruption. Therefore, our members will have in-network access to Northern Light through at least December 30, 2025, and we remain optimistic we will reach an agreement to keep them in network well beyond that date.”
Northern Light Health pledged to work with patients and group policyholders to help them understand their options for care if no contract agreement is reached.
In 2022, a contract dispute between MaineHealth and Anthem played out in public, with the health system accusing the insurer of owing millions in back payments and holding up and disputing millions more in payments, while Anthem accused MaineHealth of millions in overcharges.
Before the contract expired, both sides reached a deal, preventing MaineHealth from withdrawing from Anthem’s network.