MaineHealth says $70M in unpaid claims reason to drop Anthem

Portland-based MaineHealth's flagship hospital will exit the Anthem insurance network in January, citing more than $70 million in unpaid claims over the past three years as justification for the split, The Portland Press Herald reported April 6. 

The breakup is a big one for Mainers given that 637-bed Maine Medical Center in Portland is MaineHealth's largest hospital and Anthem is the most dominant health insurer in the state, with 69 percent market share. The precise number of enrollees to be affected by the hospital's change in network status was not available. 

"Even 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," Andrew Mueller, MD, CEO of MaineHealth, told The Portland Press Herald. "We will do everything in our power to reduce the impact of this change on our patients, however 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."

MaineHealth said Anthem has also been reducing negotiated payments to Maine Medical Center that should not be in dispute.

Anthem did not respond to The Portland Press Herald's request for comment. 

Stephanie DuBois, director of public relations for Anthem Blue Cross and Blue Shield in Maine, shared the following statement with Becker's:

"We've had a strong working relationship with MaineHealth for many years, but for the last few years we've been in discussions with them regarding unilateral increases in charges for health services provided at Maine Medical Center. This has resulted in direct higher costs to our members and all consumers that use Maine Medical Center, which is unacceptable. It's disappointing MaineHealth would choose to alarm consumers by announcing an intention to leave our care provider network when our current contract doesn't expire for another two years. We have a responsibility to those we serve, and we remain committed to resolving these yearslong issues with MaineHealth. We hope they will join us and get back to working on how we can restore affordability at Maine Medical Center."

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