Negotiations Continue Between Northern Light Health and Anthem Blue Cross Blue Shield

Portland – As of now, there haven’t been any transactions between one of Maine’s major healthcare organizations and the state’s largest health insurance provider.

The existing agreement between Northern Light Health and Anthem Blue Cross Blue Shield is set to expire at the end of September, which could affect many residents in Maine.

Officials from both organizations express optimism about reaching an agreement soon.

If negotiations stall, Northern Light Health facilities will be considered “out of network” for patients holding Anthem insurance, leading to significantly higher out-of-pocket expenses.

“Our main focus is on ensuring the sustainability of healthcare in Maine,” remarked James Rohrbaugh, Chief Financial Officer at Northern Light Health.

Both Northern Light and Anthem Blue Cross Blue Shield accuse each other of being slow to progress in the negotiation process.

Rohrbaugh argued that Anthem is likely to raise premiums while providing minimal increases in hospital reimbursements.

On the other hand, Anthem Maine President Dennis McDonough countered this claim, stating that the current contract includes adjustments in refunds that exceed inflation.

McDonough further stated that Northern Light is not meeting the expected quality care standards.

“Their compensation metrics are tied to quality indicators, so to receive full compensation, those standards have to be met,” she said.

Rohrbaugh responded by mentioning that they’ve achieved approximately 85% of the incentive metrics, which he considers quite good for insurance contracts.

He also accused Anthem of frequently refusing to cover necessary medical services.

According to Anthem, Northern Light seeks to raise patient costs by 30% over three years.

“If they get what they ask for, it could add over $218 million in costs for patients and customers in Maine,” McDonough cautioned.

She added that this would position Northern Light as the most expensive hospital in the state.

Anthem is advocating for the status quo regarding current costs.

“This is reminiscent of a similar situation three years ago with Anthem and MaineHealth,” commented Dr. Julie Peas, chair of the Maine All Care Committee.

Back then, MaineHealth threatened to pull its main hospital from Anthem’s network over claims of unpaid costs totaling millions.

Peas emphasized the need for a reevaluation of the healthcare system.

“Maine patients will ultimately bear the consequences,” she added.

Northern Light has indicated that out-of-pocket expenses at hospitals will remain unchanged until January 1, assuring patients that no immediate actions are required from them.