Maine Medical Center is threatening to end its contract with Maine Medical Center in 2023, as a billing dispute heats up.

What is MaineHealth's Issue with Anthem?

MaineHealth, which is the non-profit parent company of multiple hospitals across the state, said in a statement that the issues with the Anthem network have to do with the insurance provider's billing practices. In a statement released on Thursday, the company states that Anthem owes MaineHealth in excess of $70 million for health care services dating back over three years. In addition, MaineHealth claims Anthem has been reducing negotiated payments to MMC that should not be in dispute. In the statement, MaineHealth officials say that this issue has been seen in other states. Last week, the Georgia Office of Insurance and Fire Safety fined the insurance provider $5 for similar issues in that state.

In response, MaineHealth has announced that, effective January 2023, Maine Medical Center will no longer be an In-Network provider for Anthem. Andrew Mueller, MD, CEO of MaineHealth says the decision was not made lightly but that attempts to resolve their issues with Anthem have made little progress.

While we want to work productively with all our partners, we have to prioritize our ability to deliver the high level care our communities depend on us to provide.

 

How Will This Affect Anthem Customers in the Future?

The decision to terminate the in-network contract with Anthem will only affect patients at Maine Medical Center, and not people receiving care at any of the other MaineHealth hospitals. The decision will not prevent Anthem customers from receiving services at MMC but will increase the amount they will pay out-of-pocket for those services. Anyone who uses Anthem for their health insurer can find in-network vs. out-of-network costs listed on their policy. Under the law, Anthem must continue to fully cover emergency care at MMC, even without an in-network agreement.

This change will not affect subscribers to Anthem/MaineHealth Medicare Advantage Plans.

How Does Anthem Respond to MaineHealth's Decision?

We reached out to Anthem for a response, and they say their issues with MaineHealth stem from what they termed 'overcharging' of patients, stemming from a variety of services. As part of an agreement that's been in place for many years, Anthem company officials say they pay MaineHealth a set amount on a regular basis, in advance of services rendered.

Stephanie DuBois, Director of Public Relations for Anthem Blue Cross and Blue Shield in Maine told us a routine review in 2018 revealed overbilling by Maine Medical Center for anesthesia and operating room services. She says the company worked with MaineHealth to identify their clients that were impacted and, as a result, nearly $20 million was refunded to their customers.

It's disappointing MaineHealth would choose to alarm consumers by announcing an intention to leave our care provider network when our current contract doesn't expire for another two years. We have a responsibility to those we serve, and we remain committed to resolving these years-long issues with MaineHealth. 

 

DuBois says MaineHealth and Anthem have hired an independent mediator and hope to resolve this issue.

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