Maine
Maine Med has not reconsidered its decision to split from state’s largest insurer
Regardless of a plea from Gov. Janet Mills to keep away from a cut up, Maine’s largest hospital nonetheless plans to take the state’s largest insurer out of its community within the new yr.
On April 6, MaineHealth introduced that Mainers with Anthem Blue Cross and Blue Defend would now not be capable of obtain in-network protection at Maine Medical Heart in Portland starting in 2023. That call drew outcry from Mills, who stated it was a “drastic, damaging transfer” that ought to be reversed.
However in MaineHealth’s first in depth feedback since that announcement, well being system officers stated Wednesday that they stand behind their resolution to drop Anthem and highlighted the harm inflicted by Anthem’s practices in Maine and nationwide.
“There was no indication from Anthem that it’s ready to alter its enterprise practices in a manner that will trigger MaineHealth to rethink its resolution,” the assertion stated.
Earlier this month, MaineHealth CEO Andrew Mueller referred to as the cut up from Anthem, which won’t have an effect on every other MaineHealth amenities, an “existential” resolution — indicating that the well being system might not be capable of survive if Maine Med continued to take Anthem sufferers in-network.
The insurer owes MaineHealth greater than $70 million for providers during the last three years and has additionally been withholding funds totaling round $13 million a yr, Mueller stated.
However Anthem has responded to MaineHealth’s resolution with allegations of its personal. Firm spokesperson Stephanie DuBois stated that Maine Medical Heart has been overcharging sufferers for years, an “unacceptable” observe.
In Wednesday’s assertion, MaineHealth management stated Anthem had used billing particulars taken out of context to create a deceptive image of the hospital’s charging insurance policies.
It famous that Anthem spokespeople had used the identical tactic in disputes elsewhere. That assertion additionally referenced a choice final week by a federal arbitrator that Anthem’s observe of denying or downgrading reimbursement claims on ER visits was illegal and breached its contract with 11 Indiana hospitals. Anthem was ordered to pay the hospitals $4.5 million.
MaineHealth and Anthem have been negotiating by a mediator for the reason that April 7 announcement. Nonetheless, little seems to have modified since then.
Sufferers who go to an out-of-network hospital are likely to pay larger out-of-pocket charges. MaineHealth’s assertion stated it had not acquired any info from Anthem about what its plans have been for Anthem sufferers at Maine Medical Heart in 2023 regardless of a proper request.