SOUTH PORTLAND – A recent Maine Voices piece authored by the president of two Maine hospitals and three physicians (“Backroom deal jeopardizes health care in central, western Maine,” June 21) suggests that Anthem’s innovative provider network proposal in southern Maine is the result of a “backroom deal” that “jeopardizes” health care.
As a company that employs approximately 850 Maine residents who work every day to provide hundreds of thousands of Mainers with access to quality health care coverage and benefits, these assertions are disappointing. More importantly to you as consumers, however, they are simply not true.
We do not typically respond to inflammatory editorials. In this case, however, because the accusations are directed at an aspect of your lives that is so important — your health care –we want to set the record straight.
Here are some of the facts:
• As of Jan. 1, 2014, the Affordable Care Act requires that everyone must purchase health insurance or pay a penalty.
• Certain aspects of the ACA protect consumers and expand health insurance benefits, lower deductibles and create subsidies for many who are not able to afford insurance coverage.
• Those enhanced benefits and lower deductibles do not come free; providing them will increase costs to many individuals and small groups in Maine.
• New health insurance taxes and fees will take effect in 2014.
As Maine’s largest health insurer, and as the only insurer willing to provide unsubsidized major medical insurance in Maine’s individual market for the last 20 years, Anthem is well aware of the financial burden rising health care costs place on Maine families who purchase insurance on their own. In the face of increasing costs and a changing environment, simply passing along the increases to our members is not acceptable.
That’s why Anthem collaborated with MaineHealth and other selected providers to develop a health care provider network aimed at reducing health care costs that could be paired with our new products to slow the rate of premium increases while still providing our members with an excellent provider network.
If approved, the proposed Guided Access HMO network will be available to individual members and small businesses who choose to purchase these products from us in 10 Maine counties (Androscoggin, Cumberland, Franklin, Knox, Kennebec, Lincoln, Oxford, Sagadahoc, Waldo and York).
The authors’ suggestion that the proposed Guided Access HMO network “jeopardizes” health care is both irresponsible and demonstrably false.
The Guided Access HMO Network as proposed is a broad and deep network of quality health care providers who already serve hundreds of thousands of Mainers each year. We felt it was critical to include MaineHealth, as no other health system in Maine covers as much territory or offers as many services.
In reality, the only “jeopardy” here is if the proposed network is not approved in time for Mainers to have the choice of purchasing these lower-cost products on the federal exchange, consistent with the ACA.
While words like “backroom deal” or “secrecy” might make for salacious headlines, they lack any substance. Negotiations between health insurance carriers and providers (including the author) are conducted privately.
This is how businesses interact in a competitive market in order to drive the most value for their respective customers. State law recognizes the importance of this principle, because by law provider contracts are deemed confidential and additionally all product filings are confidential until approved.
We hope many members in the southern Maine counties will want to take advantage of this new lower-cost network. Of course, no one will be forced to buy these insurance products. For individuals buying their own insurance and for small businesses, there will be other options available.
We firmly believe that the Guided Access HMO network meets or exceeds all requirements for network adequacy. The superintendent of insurance is currently reviewing the sufficiency of the proposed network, and we would encourage anyone interested in ensuring this lower-cost option will be available, to attend the hearing Friday and share your views with the superintendent.
Dan Corcoran is president and general manager of Anthem Blue Cross and Blue Shield in Maine.