Healthcare Contract Uncertainty in Maine
Portland – Currently, there haven’t been any agreements made between one of Maine’s largest healthcare providers and the state’s biggest health insurance company.
The existing contract between Northern Light Health and Anthem Blue Cross Blue Shield ends at the close of September, creating potential repercussions for many residents.
Leaders from both organizations express a desire to finalize a deal in the coming weeks.
If no agreement is reached, Northern Light will be deemed “out of network” for those with Anthem insurance, leading to higher out-of-pocket expenses for patients.
“We’re focused on ensuring sustainable healthcare in Maine,” noted James Rohrbaugh, the Chief Financial Officer of Northern Light Health.
Both Northern Light Health and Anthem Blue Cross Blue Shield accuse each other of being uncooperative in negotiating a new agreement.
Rohrbaugh mentioned that Anthem is set to boost customer premiums while minimally increasing hospital reimbursements.
Contrarily, Anthem Maine President Dennis McDonough disputes this, claiming that the current contract includes reimbursement increases that exceed inflation rates.
Instead, McDonough asserts that Northern Light does not uphold the anticipated standard of care.
“Their compensation metrics rely on quality, so you need to meet those criteria to receive full compensation,” McDonough explained.
Rohrbaugh responded, “We’ve met about 85% of the required incentives, which is a favorable outcome in terms of insurance contracts.”
He also stated that Anthem frequently declines coverage for needed medical services.
Anthem claims that Northern Light is aiming for a 30% hike in patient costs over the next three years.
“If they agree to their terms, healthcare costs in Maine could jump by over $218 million for patients,” McDonough warned.
Additionally, he indicated this move would position Northern Light as the priciest hospital in Maine.
Anthem’s stance is to maintain current cost levels.
“This mirrors a situation we encountered with MaineHealth around three years ago,” Dr. Julie Peas, chairman of the Maine All Care Committee, remarked.
At that time, MaineHealth threatened to pull its largest hospital from Anthem’s network, citing unpaid costs in the millions.
Peas emphasized the need for a reevaluation of healthcare management.
“Ultimately, it will be Maine patients who bear the consequences,” she added.
Northern Light has indicated that patients’ out-of-pocket expenses at hospitals won’t change until January 1, so no immediate action is required from them.
