One can’t overstate the extraordinary efforts of our frontline caregivers during the pandemic. Amid the death and suffering, they delivered incredible care. Inspired by their example, the rest of our organization stepped up. We cared for thousands with COVID-19, vaccinated hundreds of thousands more and stayed open amid tremendous stress on our resources.

I couldn’t be more proud. They showed the world what it means to be a not-for-profit health care provider dedicated to the vision of “working together so our communities are the healthiest in America.”

But what if there were no MaineHealth? How might we have all fared during the pandemic without these health care heroes? As a physician, it’s unfathomable to me that our communities would have to contemplate this. Yet, that is what is at stake in our stand against the health insurer Anthem.

Maine’s largest private insurer chose last summer and fall, as the delta and omicron waves gained momentum, to unilaterally cut payments at our flagship hospital, Maine Medical Center. This comes amid a series of egregious practices by Anthem that have disrupted care and left a wake of penalties and adverse rulings across the country.

So in March we made the difficult decision to remove Maine Medical Center from the Anthem network as of Jan. 1, 2023, a decision we stand by today.

We know that, even though Anthem subscribers will have nine months to prepare, this will affect them, and we deeply regret having to do this. But we did it because Anthem’s behavior poses an existential threat to MaineHealth and Maine Medical Center.

Anthem continues to substitute its judgment for that of our physicians, excessively denying claims for care delivered and prior authorizations for care that is needed. As was reported by the Maine Hospital Association, across Maine Anthem has failed to pay claims to hospitals and independent providers totaling more than $350 million. Anthem continues to implement new policies unilaterally, reducing payments below agreed upon rates. Though we are committed to doing still more to control costs, numerous independent reports, such as the one here, place Maine and MaineHealth in the middle of the pack nationally when it comes to cost. Yet, Anthem keeps making unsubstantiated claims about overcharging by MaineHealth to justify its conduct.

These actions at Maine Medical Center directly impact our ability to provide care, especially in hard-to-serve rural communities, as MMC is our clinical and financial engine. In order to maintain our clinical, social and economic presence in these communities, we need a fundamental change in our relationship with Anthem.

We’ve remained at the table since the fall. Most recently, Anthem presented what it described as a “framework” for full settlement, and we entered near-daily conversations with them, ready to compromise. Unfortunately, Anthem refused to compromise further any time we sought change that would actually alter how they do business with us.

Anthem isn’t the only commercial insurer in Maine, and, yes, issues arise with the other payers. The difference is that we are able to have a meaningful dialogue about improving quality and lowering the cost of care with those insurers. Anthem, on the other hand, is unrelenting in squeezing every claim.

I share this now for the same reason we announced our intention to remove MMC from the Anthem network nine months in advance. Our patients with Anthem coverage and their employers need time to prepare. We ourselves will discontinue having Anthem administer the health insurance plan for our care team as of Jan. 1, to guarantee access to the region’s premier medical center.

We are not the only provider who has struggled with Anthem. Here in Maine, the complaints have been widespread, and medical practices have had to threaten to leave their network just to get a fair contract.

And this goes well beyond Maine. Across the country there are many other examples of Anthem being held accountable for its behavior, including a March decision by the state of Georgia to impose a $5 million fine against Anthem for illegal practices that harmed its policy holders.

These remain difficult times in health care. The pandemic is evolving, but not going away. Other problems, such as the health care labor shortage, are growing worse. Through it all, we are committed to being here for you. That’s a promise we can only keep, however, if we work together with organizations that put our communities first.

— Special to the Press Herald