Sunday, April 20, 2014
AUGUSTA – Anthem Blue Cross and Blue Shield said Monday that individual subscribers in Maine who buy its new insurance product, which includes only 32 out of 38 hospitals in the state, will save about 12 percent compared with a broader plan.
Anthem, the state's largest insurer, and MaineHealth, the state's largest network of hospitals and care providers, plan to offer an insurance network on the health exchange being created in Maine under President Obama's Affordable Care Act.
The planned network excludes three hospitals owned by Central Maine Healthcare in Lewiston, as well as Mercy Hospital in Portland, Parkview Adventist Hospital in Brunswick and York Hospital in York.
In a hearing before the state Bureau of Insurance, Anthem answered questions about its plan to transfer existing individual subscribers to new insurance plans. The change would affect about 9,000 people, Anthem said. The insurer provides coverage to about 320,000 subscribers in a range of plans.
Chris Dugan, a spokesman for Anthem, said fewer than 10 percent of the individual subscribers, or fewer than 1,000 people, use primary care physicians and specialists who are not in the new narrow network.
The provider network and pricing system have already been approved by the state insurance bureau.
Executives from MaineHealth and St. Mary's Regional Medical Center testified on Monday that they agreed to take reduced reimbursement rates from Anthem in exchange for the insurer directing more of its subscribers to their hospitals. The specific details of the contracts were not disclosed.
Critics have argued that the narrow plan would disrupt care for subscribers in central and western Maine, who would have to change doctors or chose a new insurance plan.
"As consumers and patients, we don't deserve being brought up against a corporate giant that is for-profit," said Donna Goodrich, a nurse from Greenwood. She is not an individual Anthem subscriber, but spoke during the public comment period of the hearing.
None of the 10 speakers at the evening public comment period were affected by the change in the individual plans, but spoke generally against the Anthem-MaineHealth partnership.
Although critics have said the Anthem-MaineHealth pact goes against Obama's pledge that consumers would not have to change doctors, the emergence of so-called narrow networks that exclude certain hospitals or providers is a trend emerging in other states as well.
In New Hampshire, for example, Anthem has proposed a similar narrow network for that state's insurance marketplace.
Anthem has said individuals would have choices among its plans, as well as a competing plan on the health exchange offered by Maine Community Health Options, which has a proposed network of 34 hospitals.
Outside of the exchange, Mega Life and Harvard Pilgrim will also offer individual health insurance options.
"Many consumers will chose a better price," said Dugan. "If they want to stay with their current doctor, we respect that and they can purchase another product."
Jessica Hall can be contacted at 791-6316 or at: