July 26, 2013

Anthem-MaineHealth network approved – with conditions

A rival health network blasts the partnership as a 'backroom deal' that discriminates against central and western Maine.

By Jessica Hall jhall@pressherald.com
Staff Writer

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A nurse practitioner at the India Street Public Health Clinic in Portland examines a patient.

2012 Press Herald File Photo / Gregory Rec

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Under the Affordable Care Act, people can purchase health insurance starting Oct. 1 on the exchanges for coverage that begins in January. Those earning 100 percent to 400 percent of the federal poverty line will be eligible for subsidies on the exchanges. The health insurance exchange will target the roughly 260,000 Mainers who have individual or small-group insurance plans and those who are now uninsured.

Only the Anthem and Maine Community Health Options, a nonprofit co-op insurance plan, have applied to compete on the exchange in Maine. The plans offered by Maine Community Health Options would cover the entire state.

Central Maine HealthCare maintained Thursday that the Anthem network would fail to provide reasonable access to care for its subscribers.

"We don't believe driving an hour to receive primary care is reasonable service," Gill said, describing potential situations when Anthem HMO customers in western Maine would have to drive to Portland to see their doctor. "We don't believe that's reasonable access to care."

Gill said while it's true that many individuals living in western Maine who purchase insurance on the exchanges would instead choose Maine Community Health Options, some may not have that choice.

"What if I live in Rumford and my employer in Lewiston chooses the Anthem plan?" Gill asked.

Anthem and MaineHealth previously said that the proposed network, which excludes certain providers, would help cut costs. MaineHealth, for example, agreed to take lower reimbursement rates in exchange for more customers being directed to its network of hospitals and caregivers.

"Anthem Blue Cross and Blue Shield in Maine is pleased that our proposed network has been approved by the Maine Bureau of Insurance subject to conditions, which we are taking the necessary steps to meet," Anthem spokesman Chris Dugan said in a statement.

The new network will be available for customers who choose to purchase Anthem's individual or small group plans for 2014.

"Simply passing along increasing costs in the form of higher premiums is not acceptable. That's why Anthem collaborated with MaineHealth and selected providers across the state to develop a comprehensive provider network that could be paired with the new products to slow the rate of premium increases," Dugan said.

The proposed plans from Anthem-MaineHealth and Maine Community Health Options are subject to federal approval.

-- Staff Writer Joe Lawlor contributed to this story.

Staff Writer Jessica Hall can be contacted at 791-6316 or at:

jhall@pressherald.com

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