Contract Talks Stalled Between Northern Light Health and Anthem
Negotiations between Northern Light Health and Anthem are at a standstill.
This comes three years after a significant dispute between National Anthem, Maine’s largest health insurer, and Maine Health, the state’s biggest health system, which operates hospitals in Portland and Belfast.
On Wednesday, Northern Light Health announced that the current contract with Anthem will end on September 30, 2025, unless Anthem agrees to increase its reimbursement rates.
If no agreement is reached, Northern Light’s hospitals, located in areas from Presque Isle to Bangor to Ellsworth, will exit the Anthem network in Maine.
James Rohrbaugh, the vice president and CFO of Northern Light Health, pointed out that Anthem’s reimbursement rate has grown at below 1.5%, which is significantly lower than the average annual inflation rate of 7.5% for health services. He emphasized that adequate reimbursement is essential for keeping hospitals, practices, and staff operational.
“Anthem’s approach to addressing care costs has serious implications for rural healthcare,” Rohrbaugh stated.
Northern Light Health also reported an increase in Anthem’s refusal to cover patient care and noted a 10% rise in profit margins in Maine.
Anthem spokesman Matt Wheeler responded, stating that discussions are ongoing to ensure members have access to affordable care at Northern Light’s facilities until December 30, 2025.
He added, “The statement from Northern Light regarding September 30 is misleading. The existing agreement remains effective through that date and includes a minimum 90-day extension to facilitate continued negotiations and avoid disruption in care for members.”
Northern Light Health has expressed its commitment to assist patients and group policyholders in understanding their care options if a new contract cannot be finalized.
A public contract dispute occurred in 2022 between MaineHealth and Anthem, where both sides exchanged accusations regarding payments and fees. Ultimately, they reached an agreement before the contract expired, preventing MaineHealth from withdrawing from Anthem’s network.
