Northern Light Health’s contract with Anthem Insurance has come to an end after months of negotiation failure during mediation. While some organizations may still be working on agreements, many patients will start facing out-of-network fees from today.
If you receive care from Northern Light and have insurance through Anthem, here’s what to keep in mind:
What types of care are currently considered out of network?
For those with private or employer-based Anthem insurance, primary care providers are now out of network. Fortunately, hospital care will still be covered until year’s end.
Patients with an Anthem Medicare Advantage plan will continue to have coverage for both primary and hospital care through the end of this year.
Emergency room visits will always be covered at in-network rates. Federal legislation passed in 2022 protects patients from unexpected medical bills, particularly for emergency services.
Is it still possible for Northern Light and Anthem to reach an agreement?
Yes, ongoing negotiations between health systems and insurance companies can occur even after contract deadlines. However, for now, Northern Light is out of network, and both parties will remain that way until a new contract is finalized. Whether mediation will resume or proceed is still uncertain.
Earlier this year, Anthem faced a similar situation with a Missouri Health System, resulting in a three-month disruption for many patients.
What are my options?
Patients with private or employer-based Anthem insurance will need to pay out-of-pocket for services from Northern Light’s primary care providers. Some are contemplating switching insurance plans or seeking new doctors.
The Maine Insurance Market has an open registration period running from November 1 to January 15, with coverage starting on January 1 if registered by December 15.
For Medicare Advantage users, the open enrollment window is from October 15 to December 7.
Individuals insured through their employers may have to explore other options as many companies, including the state of Maine, offer Anthem insurance to their staff.
Anthem clients can also look for other in-network providers through Anthem’s website.
What happens if I have serious health conditions?
Patients receiving long-term care from Northern Light may still be able to access these services at in-network costs for a limited time through something known as “Continuity of Care.”
qualifying conditions for this arrangement might include pregnancy, serious illnesses like cancer, upcoming transplants, terminal illnesses, major surgeries, and various acute or chronic diseases.
Patients who may be eligible should reach out using the number on their insurance card for more information.
