Anthem Blue Cross and Blue Shield said it is still deciding what to do next after a decision by state Superintendent of Insurance Eric Cioppa to partially reject proposed policy changes related to the Affordable Care Act.
Cioppa made his decision Friday in response to a proposed insurance-plan restructuring that would have required some Anthem customers in southern and western Maine to change physicians.
Anthem, the state’s largest health insurer, has argued that the restructuring to a narrower plan with fewer choices would significantly lower its customers’ insurance premiums.
Anthem spokesman Christopher Dugan said in a written statement Tuesday that the company is reviewing Cioppa’s decision to determine what steps to take next.
“We continue to believe that our proposal to replace existing plans with new plans that offered a network with reasonable and comprehensive access to services at a premium that would have been 12 percent lower is in the best interest of our members,” he said.
Dugan would not say how many Anthem policyholders were directly affected by Cioppa’s ruling. The number is reported to be less than 1,000.
While Anthem insures about 320,000 Mainers, the vast majority have group insurance plans through their employers. Anthem’s proposed policy change only applies to a small segment of its 9,000 individual policy customers who have signed up since March 2010.
Individual policyholders whose memberships predate the March 2010 passage of the Affordable Care Act cannot be forced to change plans.
Anthem’s pricing and network, which excludes six of Maine’s 38 hospitals, already has been approved for new customers who sign up through the Affordable Care Act marketplace.
State Bureau of Insurance spokesman Doug Dunbar said Anthem has not yet filed an alternative proposal or advised the bureau what action it will take.
“The process going forward depends on whether Anthem complies with the decision or appeals, or perhaps even does both, complying under protest while filing an appeal,” Dunbar said. “If Anthem makes a filing to comply, the bureau will act quickly.”
Cioppa’s decision says that Anthem, the state’s largest health insurance provider, must devise a new plan for policyholders in southern and western Maine that imposes fewer restrictions on their options for subsidized care under the federal Affordable Care Act.
The decision was a win for Central Maine Medical Center and its parent organization, Central Maine Healthcare, which has been the most vocal critic of Anthem’s proposed changes.
The changes would preclude some patients from receiving subsidized care at Central Maine Healthcare’s three hospitals, as well as three others, including Mercy Hospital in Portland.
Anthem has partnered with MaineHealth, the state’s largest owner of hospitals and other medical facilities, to offer a new insurance network on the health insurance marketplace created in Maine under the Affordable Care Act.
Anthem wants to move individual-plan policyholders who are not “grandfathered” into their current plans to the new network, which excludes Parkview Adventist Medical Center in Brunswick, York Hospital, Mercy Hospital in Portland and the three hospitals owned by Central Maine Healthcare of Lewiston.
Central Maine Healthcare operates Central Maine Medical Center in Lewiston, Rumford Hospital and Bridgton Hospital.
The state Bureau of Insurance held four public hearings on the proposed changes.
Throughout the hearings, Central Maine officials slammed the Anthem-MaineHealth plan as discriminating against insurance subscribers in central and western Maine, who could have to travel farther to reach doctors in the plan.
Some of Anthem’s policyholders also criticized the insurance provider for policies that they said appeared to conflict with federal law and with statements made by President Obama, that people who like their doctors or insurance plans can keep them under the Affordable Care Act.
In the end, Cioppa’s decision was mixed.
He approved the change in Maine’s six northern and eastern counties, where he said access to health care under Anthem’s plan would be more than adequate.
However, Cioppa denied the proposed change in 10 southern and western counties, including Cumberland, York and Kennebec.
Anthem is likely to be the biggest player in Maine’s new health insurance marketplace.
A competing network is being offered by Maine Community Health Options, which offers coverage at all 38 hospitals in Maine.