About 30,000 residents in Maine might find themselves without access to doctors, specialists, or nurses as of Saturday morning.
MAINE, USA — It looks like Northern Light Health and Anthem Insurance won’t come to an agreement before Friday’s deadline.
Both Northern Light Health and Anthem Insurance released statements on Friday evening, confirming that the contract negotiation isn’t close to being finalized.
The two entities have been in discussions for several months about reimbursement rates, yet there has been minimal advancement. Initially, the deadline was set for October 1st, but both parties chose to push it back to midnight tonight. If they can’t reach an agreement or decide to extend it further, Northern Light’s primary care doctors will no longer be part of Anthem’s network starting November 1st.
However, even if that occurs, state officials mention that Maine has certain legal protections in place. The state’s insurance law mandates that health plans offer “reasonable access”to healthcare, whether through in-network or out-of-network options. It’s worth noting that the law doesn’t specifically define what “reasonable access” means.
Maine also has a continuity of care law designed to assist patients in maintaining their healthcare providers during these transitions. This law requires insurance companies to allow patients receiving ongoing treatment to continue with a provider who is no longer in the network without incurring higher costs.
Bob Carey, director of the Maine Department of Health Services, provided a few examples of how these continuity protections function.
“We will not force you to switch to a different OB/GYN, for instance, if you’re just weeks from giving birth or undergoing treatment for cancer,” he explained.
The approaching deadline particularly affects Northern Light employees who offer outpatient services, like annual check-ups, to Anthem clients through private or employer-sponsored plans. Medicare clients with Anthem will maintain their coverage until the year’s end.
Urgent care services will still be in-network for all Anthem customers at all times, adhering to federal regulations.
There’s another important deadline for Anthem clients to remember: December 31, when Northern Light Hospital will exit the network.
Carey noted that this deadline pertains to inpatient care: “If you get admitted to one of our Northern Light facilities, that facility will be treated as in-network. Services provided while in that facility should be billed at in-network rates.”
Anthem has established a dedicated website to offer current updates and insights regarding the ongoing contract negotiations. Additionally, the Maine Department of Insurance recommends that those enrolled in Anthem plans call the number on their insurance card before visiting a Northern Light provider to confirm their coverage and any potential costs involved.
