July 3, 2013

Anthem's proposed network wouldn't cover all Maine towns

Central Maine HealthCare, which wouldn't be in Anthem's network, says Anthem's proposal underestimates the driving time to doctors in central and western Maine.

By Jessica Hall jhall@pressherald.com
Staff Writer

GARDINER — Anthem Blue Cross and Blue Shield on Tuesday acknowledged that not every town in the state would have a doctor in the health insurance network it has proposed.

click image to enlarge

In this 2012 file photo, Linda Farley and Sharon Wallace, right, care for a patient at Maine Medical Center in Portland. Anthem Blue Cross and Blue Shield on Tuesday said it would have sufficient numbers of primary care physicians and specialists in its proposed health insurance network, but it acknowledged that not every town in the state would have a doctor in the network.

Staff Photo by Herb Swanson

Anthem has proposed creating a health insurance network with MaineHealth that includes 32 of the 38 hospitals in the state. It previously said the network was structured to allow every subscriber to reach a primary care physician within a 30-minute drive and a specialist within an hour's driving time.

In a hearing held by the state's Bureau of Insurance, Anthem said the network was built around MaineHealth, the largest network of hospitals and care providers in the state.

The company said it does not know how many Mainers would join the network. It used an estimate of 45,000 subscribers, however, to calculate various ratios of doctors to patients that the state will use in deciding whether to approve the network.

"We've have many discussions with MaineHealth to take on more primary care," said Colin McHugh, Anthem's regional vice president of provider engagement and contracting, said Tuesday in testimony before the Bureau of Insurance. "We will work closely with the provider community to make sure members' needs are met."

The proposed network has come under fire, with some hospitals and doctors upset that they were not included, and some patients fearful that they would no longer be able to go to their current medical providers. 

The proposed network excludes Central Maine Healthcare of Lewiston, along with Parkview Adventist in Brunswick, York Hospital in York and Mercy Hospital in Portland.

Central Maine Healthcare -- the parent of Central Maine Medical Center in Lewiston and Bridgton and Rumford hospitals -- has slammed the Anthem-MaineHealth plan as a "backroom" deal that discriminates against consumers in central and western Maine.

Chuck Gill, a spokesman for Central Maine HealthCare, said Anthem's projections underestimate the driving time it would take customers in central and western Maine to reach providers in the network.

"Anthem's theory is that if we have a doctor in a particular county, then that's sufficient coverage. But if you live in Fryeburg and you need to see a doctor in Norway, that's more than 30 minutes away," Gill said. "Try going from Rumford to Portland. That's one-and-a-half hours."

Gill also said that Anthem needed to adjust its forecasts for how many potential patients may sign up for the network. Anthem has said it cannot predict how many subscribers will sign up.

"It's still incredible to me that Anthem is offering a product and not expecting any people to sign up for it," Gill said. "That's the fable of this hearing."

Anthem said the industry uses outdated benchmarks to make sure there are sufficient primary care doctors to treat a particular patient population. One benchmark suggests there should be one primary care physician for every 2,000 patients.

"The delivery of primary care is undergoing massive change. We at Anthem are changing the way we pay doctors and they are adjusting how many physician assistants and nurse practitioners they use so patient panels can be increased," McHugh said.

The proposed Anthem-MaineHealth network is one of two plans that would be sold through the insurance exchange to be created in Maine under the federal Affordable Care Act. The other plan is proposed by Maine Community Health Options, a nonprofit, co-op insurance program. Both plans must be reviewed by the Bureau of Insurance by July 31 and get approval from federal regulators.

The health insurance exchange will target the roughly 260,000 Mainers who have individual or small-group insurance plans and those who now are uninsured. Enrollment is expected to begin in October. The plans would take effect Jan. 1.

"This offers consumers a broad network," McHugh said. "It is our intent to provider a lower-cost product for the exchange environment."

Details on pricing and structure of the plans have not been released and were not the focus of Tuesday's hearing.

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

jhall@pressherald.com

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