Our relationship with Anthem has reached a point where it is hurting our ability to sustain the level of care our communities have come to expect from MaineHealth and its flagship hospital, Maine Medical Center.
The decision to pull MMC out of the Anthem network is based on how the insurer’s practices in recent years have impacted MMC and its patients. Anthem owes MaineHealth in excess of $70 million for health care services dating back over three years. Anthem has also been reducing negotiated payments to MMC that should not be in dispute.
As has been reported in the news in recent months, Anthem has been struggling with making payments on time to many health care providers across Maine, including Maine Medical Center, blaming system errors for the problem. Anthem also has been denying prior authorizations and referrals for needed care, forcing patients and their physicians to appeal or resubmit claims. Last summer, Anthem denied proper reimbursement to in-network providers because it was using incorrect provider identification numbers. As a result, Anthem incorrectly denied claims for 10,000 MaineHealth accounts.
While the insurer has said publicly that it is fixing its systems and putting its problems behind it, that has not been the experience of MaineHealth. On March 29, 2022, the Georgia Office of Insurance and Fire Safety fined Anthem $5 million for practices similar to what MaineHealth has experienced.