Saturday, December 7, 2013
Central Maine Medical Center is a winner as Anthem must devise new plan for many policyholders.
The state’s top insurance regulator was right to decide that Anthem Blue Cross and Blue Shield should allow current customers to keep receiving care at Central Maine Medical Center in Lewiston and five other hospitals in Maine, a spokesman for the hospital said Monday.
Superintendent of Insurance Eric 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.
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 did not respond Monday to questions about what it will do in response to Cioppa’s decision, or what the decision means for affected policy holders.
The company 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 six of Maine’s 38 hospitals: 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, which would affect a relatively small portion of Anthem’s 9,000 individual-plan customers.
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.
He instructed Anthem to renew those customers’ existing plans or come up with alternatives that “retain the existing broad network and do not totally exclude benefits for out-of-network services.”
On Monday, Central Maine Medical Center spokesman Chuck Gill said the public hearing process and Cioppa’s decision brought to light two important lessons for health-insurance providers.
First, the provider’s transition to Affordable Care Act compliance should not force policyholders to sever their doctor-patient relationships, Gill said.
Second, consumers want the ability to get health care close to where they live, he said.
Gill described Cioppa’s decision as a win for patients.
“When government listens to the people, government works,” he said.
Anthem and MaineHealth already have approval from the bureau for the plan to partner on the health insurance exchange.
Their provider network and pricing also have been approved.
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 said it offers coverage at all 38 hospitals in Maine.
J. Craig Anderson can be contacted at 791-6390 or at: