As some Maine providers drop Anthem, others join

Two Northern Light Health hospitals in Maine are becoming tier 1 providers with Anthem, effective July 1, according to WCSH.

Anthem members under individual, small and large group plans will be able to visit Northern Light Inland Hospital in Waterville and Northern Light Mercy Hospital in Portland. 

Members "could see significant savings in cost shares for healthcare services — such as lower copays for primary care physician and specialist office visits, lower coinsurance costs, and up to $3,000 in savings on deductibles, depending on the plan," according to WCSH.

The addition of the two hospitals means all 10 of Northern Light Health's hospitals are now in the top tier for Anthem's Maine HMO Tiered Options Plans.

The move comes after Portland-based MaineHealth's flagship hospital, Maine Medical Center, said it would exit the Anthem network in January, citing more than $70 million in unpaid claims over the past three years.

In May, Fore River Urology in Portland said it would be out of network with commercial Anthem plans by Aug. 1 and Medicare Advantage plans by Sept. 1. The independent medical practice said the two could not come to an agreement over reimbursement rates amid rising inflation.

Another disagreement over reimbursement rates between Anthem and a Maine provider occurred in late May with Scarborough-based Coastal Women's Healthcare. Anthem members will be out of network with the state's largest independent OB-GYN practice starting Aug. 23.

WCSH asked Northern Light about the alleged outstanding payments between Anthem and MaineHealth.

"We do continue to experience some delays with out of state and Medicare Advantage claims, and we are still meeting monthly with Anthem to review outstanding issues," a spokesperson said. "Northern Light Health is delighted to be working with other Maine healthcare providers participating in this network."

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