To Our Patients with Anthem Coverage

MaineHealth has made the difficult decision to serve notice to the health insurer Anthem that, beginning in 2023, Maine Medical Center will no longer be an in-network provider of non-emergency care for those with Anthem commercial coverage.

Even though Anthem subscribers will have nine months to prepare, we know that this will affect many of you, 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 (MMC).

MaineHealth has only served notice for Maine Medical Center to be removed from the Anthem network, as MMC has been the focus for Anthem. While we remain in discussions with Anthem, we are not optimistic for any change. Also, we have not sought to remove our physicians and providers in our system-wide medical group from the Anthem network nor other MaineHealth hospitals. 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.

So what does this mean for you and other Anthem subscribers? Maine Medical Center 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. Under the law, emergency services at Maine Medical Center must be fully covered by Anthem.

Exactly how you might be impacted by this change, and to what degree MaineHealth can assist in the process, will depend on how Anthem decides to handle MMC ‘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.

If you would like more information about our decision, please view our frequently asked questions page.

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. Anthem has been struggling with making payments on time to many health care providers across Maine, including MMC, 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.

We know for our patients with Anthem commercial insurance, this creates some challenge and uncertainty, but we firmly believe that this change will serve the interests of our patients and the communities we serve over the long-term. This is why we are providing notice far in advance.

Thank you for choosing MaineHealth for your health care. As a not-for-profit provider of care, every dollar we earn is reinvested into our care team and the communities we serve, and we will continue to strive for excellence in providing the great care that you’ve come to expect from MaineHealth and Maine Medical Center.

Regards,

Andrew Mueller signature

Andrew Mueller, MD
CEO, MaineHealth