Anthem, MaineHealth dispute sparks state investigation into payer, market concerns from officials

Maine Medical Center's plan to leave Anthem's insurance network in January could cause a significant disruption to the state's health insurance markets and has spurred an investigation into the payer's payment practices, according to the Portland Press Herald.

The hospital, Portland-based MaineHealth's flagship, cited more than $70 million in unpaid claims from Anthem over the past three years as justification for the split.

Maine Hospital Association President Steven Michaud told the Herald the split involves the state's biggest tertiary care hospital and largest payer. Indianapolis-based Anthem provides health coverage to 54 percent of the state's residents.

"You almost can’t comprehend how disruptive it would be," Mr. Michaud said. 

About 150,000 people with an Anthem plan made a claim at Maine Medical Center in the past three years, the Herald reported. 

Maine Gov. Janet Mills said in an April 6 statement that she is deeply concerned about the potential contract termination and that it should be avoided at all costs. She said the split would significantly harm the cost and access of care for the state's Anthem customers, particularly those in southern Maine. 

Despite Maine Medical Center's announcement, Mr. Michaud said there is a lot of motivation for the sides to resolve the issues and said he is confident the departure won't happen.  

The contract dispute has led the Maine Bureau of Insurance to investigate Anthem through a market conduct examination, a move welcomed by healthcare organizations in the state, according to the Herald.

"The bureau is conducting a market conduct examination of Anthem, which will include a review of provider payment issues. The exam is expected to continue for several months. At this time, Anthem has worked through most of its backlog of claims," a bureau spokesperson told the Herald.

The alleged provider payment issues from Anthem aren't limited to just the MaineHealth network, according to the Herald

Jeffrey Barkin, MD, is president of the Maine Medical Association and said individual providers in the state have faced underpaid claims, a high proportion of denied claims and nonrecognition of national identification numbers from Anthem, leaving some providers to stop accepting the payer.

"The Maine Medical Association would like to see a harmonious relationship between providers and payers, but this sort of behavior directed toward hospitals, toward doctors, has absolutely no place in the healthcare ecosystem," Dr. Barkin told the Herald.

In a statement to the Herald, Anthem said it strives to pay claims as efficiently and quickly as possible in accordance with contracts it has with providers. Over the last year, the payer said it processed 92 percent of claims within 14 days and 98 percent of claims within 30 days.

Anthem also set up a dedicated Maine provider assistance team to deal with the issues.

"We're proud of our progress, but these are complex issues that take time to address properly and we are committed to resolving them. We have communicated our progress to providers across Maine, and we will continue that direct dialogue as we continue to resolve these challenges," a spokesperson said.

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