Anthem Contract Frequently Asked Questions

MaineHealth has made the difficult decision that Maine Medical Center will no longer participate as an in-network provider of non-emergency care for Anthem’s commercial subscribers starting in January of 2023. Though Anthem subscribers will have nine months to prepare, we know that this will affect many of our patients, and we deeply regret having to take this step. While we will do everything in our power to reduce the impact of this change on our patients, 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

Yes. Our contract does not change with Anthem until January of 2023, thus this termination notice would not change that in-network status until that time.

Maine Medical Center’s leaving the Anthem network would not necessarily prevent Anthem’s commercial subscribers from using the hospital, but insurers typically do not cover care obtained from out-of-network providers at the same level as those that are in-network. Patients often have to pay more out-of-pocket to use a provider out of an insurer’s network. If you have questions about how your individual plan may be impacted, please call Anthem member services as listed on the back of your insurance card.

MaineHealth has no plans to remove its physicians and other providers in its system-wide medical group from the Anthem network.

MaineHealth has no plans to remove any other MaineHealth hospital from the Anthem network and has served notice only for Maine Medical Center to leave the Anthem network in 2023. This is because MMC has been a focal point for Anthem. MaineHealth hopes this approach will minimize any disruption.

Under the law, Anthem must continue to fully cover emergency care at Maine Medical Center even without an in-network agreement.

For subscribers to Anthem|MaineHealth Medicare Advantage plans, MaineHealth has advised Anthem that it intends for MMC to continue to remain in the Anthem network.

Starting in 2023, Maine Medical Center will be out of network for those who get Anthem coverage from their employer as well as those who buy insurance directly from Anthem, including through the Affordable Care Act’s exchange.

Maine Medical Center will be out of network for Anthem’s commercial subscribers in New Hampshire and elsewhere, as that access depends on the network agreement made in between Anthem and the hospital in Maine.

How someone with Anthem coverage might be impacted by this change, and to what degree MaineHealth can assist in the process, will depend on how Anthem decides to handle Maine Medical Center’s withdrawal from its network. If you have further questions about how your individual plan may be impacted, please call Anthem member services at the number listed on the back of your insurance card.

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.

MaineHealth is willing to continue to talk with Anthem about these concerns, but at this point employers and individual subscribers should assume that Maine Medical Center will not be part of the Anthem network in 2023 and beyond.