Northern Light Health Challenges Anthem Over Mediation Dispute

Northern Light Health has responded vigorously, using the national anthem to express its concerns about the state’s largest private insurer, Anthem, allegedly obstructing mediation efforts.

As both parties approach Tuesday’s deadline to secure a contract, the potential fallout is significant. If they can’t reach an agreement, the hospitals and primary care services under Northern Light will be out of Anthem’s network starting Wednesday.

A failure to finalize this contract could impact around 30,000 Mainers, including state employees.

In a letter sent Friday to Anthem’s leadership, Timothy Dentry, the president and CEO of Northern Light Health, expressed frustration over Anthem’s recent statement claiming Northern Light had exited mediation discussions.

“We have never indicated that we are disengaged from mediation. On the contrary, we’re fully engaged and ready to work towards a resolution,” he asserted in the letter directed at Maine’s Anthem President, Dennis McDonough.

This week, Anthem issued a complaint alleging Northern Light Health had withdrawn from mediation despite offering a 5% increase to commercial accounts. They further claimed that Northern Light’s proposed contract changes could prevent customers from auditing care to avoid overpayment.

A spokesperson for Northern Light refuted those claims, labeling them as “false.”

In his Friday statement, Dentry argued that Anthem’s public stance violated mediation principles, eroding trust between the two organizations.

“This entire process isn’t merely about reimbursements. It’s about how we collaborate to ensure high-quality care,” Dentry noted.

“Sadly, your organization has made this increasingly difficult,” he added.

In response, Anthem expressed eagerness to resume discussions with Northern Light next week.

“Anthem is dedicated to keeping healthcare costs as affordable as possible for our members and employers. Our latest offers to Northern Light Health are aligned with what other healthcare systems in Maine receive,” Anthem stated.

They also reiterated their disagreement with Northern Light’s assertion against routine claims audits, stating, “These audits are crucial to ensure our customers aren’t overpaying for care.”

The ongoing public dispute between Northern Light and Anthem isn’t new. They have exchanged criticisms throughout the summer while trying to negotiate a contract.

James Rollbaugh, Northern Light’s executive vice president and CFO, pointed out in June that Anthem’s reimbursement rates had risen by less than 1.5%, despite health service inflation averaging around 7.5%. Northern Light emphasized that adequate reimbursement is essential for maintaining operations and staffing.

Additionally, Northern Light cited an increase in Anthem’s denials of payment for patient care alongside a 10% rise in Anthem’s profit margins in Maine.

Northern Light suspended contract negotiations with Anthem in mid-August. When they did so, they had submitted a counteroffer on July 30, which Anthem failed to respond to. Negotiations were resumed later that month and both sides entered mediation.

Dentry voiced additional criticisms of Anthem on Friday. He mentioned that Anthem’s actions have been causing “confusion,” “delays,” and “unnecessary stress” for patients battling serious illnesses like cancer. Recently, patients were directed to complete an online “continuous care” form to ensure coverage, but last week Dentry claimed Anthem had started asking patients to call instead, complicating matters.

Dentry called this an “unacceptable burden” for families seeking critical care.

“To be clear, medical decisions should rest with healthcare professionals, not dictated by opaque, profit-driven processes. Our doctors shouldn’t have to navigate insurance bureaucracy over forms or misinformation,” he asserted.

He noted that Northern Light had successfully completed negotiations with Harvard Pilgrim and community health options without similar public disputes, but faced ongoing resistance from Anthem during this negotiation process.

“Our aim remains straightforward: to provide care to our patients and the community without interruptions. Right now, Anthem is hindering that mission,” Dentry explained, revealing that he will soon step down as leader of Northern Light Health, with Guy Hudson set to take over next month.

This isn’t the first time a contract dispute between MaineHealth and Anthem has unfolded publicly; in 2022, a similar standoff resulted in accusations from both sides over millions in payments. Ultimately, a deal was reached just before the contract expired, averting MaineHealth’s exit from the Anthem network.