The main entrance area of Maine Medical Center in Portland. Gregory Rec/Staff Photographer, file

After months of seemingly stalled talks, Anthem insurance and MaineHealth say they are starting to make progress in a dispute over reimbursements.

MaineHealth has threatened to pull Maine Medical Center in Portland from Anthem’s network in January unless they reach an agreement. That would mean thousands of Mainers would have to pay higher out-of-network fees at the hospital or find other medical providers who are in Anthem’s network.

The dispute pits two health care heavyweights – MaineHealth is the state’s largest health care provider and Indianapolis-based Anthem is one of the nation’s largest health insurance companies, providing coverage to people in 14 states that include Maine, where it is the largest insurer.

With 300,000 members statewide, Anthem represents 54 percent of the insurance market in Maine and about 150,000 Maine Med patients have used Anthem insurance in recent years. If Maine Med did pull out of the Anthem network, it could roil the health care market in the state.

The two sides had seemed to be making little progress in their talks, but Anthem suggested Monday that might be changing.

“We are optimistic that we are making progress on coming to an agreement that protects the Maine consumer and keeps Maine Medical Center in our care provider network beyond Dec. 31, 2022,” a statement from Anthem said.


The two sides have been in both direct and mediated negotiations, Stephanie Dubois, director of public relations for Anthem Blue Cross and Blue Shield in Maine, said in the statement.

She said both sides “are working around the clock” to reach an agreement.

John Porter, the spokesman for MaineHealth, agreed that both sides “are working diligently to resolve the outstanding issues,” but cautioned that there are still a lot of issues to be resolved.

“We still have many details to work through in order to reach an agreement,” Porter said in a statement.

The dispute is over money: MaineHealth says Anthem has been denying full payments for services from MaineHealth’s providers, while Anthem said the health care organization is overcharging, particularly for medications.

MaineHealth – the parent organization of Maine Med in Portland and seven other Maine hospitals and one in New Hampshire – has accused Anthem of shortchanging its health care providers by denying payments for services rendered. Anthem says MaineHealth routinely overcharges for medications. Both sides have provided examples, such as Maine Med charging $136 for a $2 bag of saline solution, and Anthem only agreeing to pay for one of two heart stent procedures performed on the same patient in the same day.


Contract disputes with Anthem and hospital networks in recent years have played out in Indiana, Georgia, California, Virginia, Colorado, New York, Nevada, Ohio and Connecticut.


While disputes like the one between Anthem and MaineHealth are fairly common, only a handful have resulted in a major hospital actually withdrawing from an insurer’s network. And in most cases where that did happen, the disputes were typically settled fairly quickly and the insurers retroactively classified the hospitals as in-network so patients didn’t have to pay higher out-of-network fees for care they received during the dispute.

However, there already has been some fallout. Fore River Urology in South Portland announced in May that it was leaving the Anthem insurance network starting on Aug. 1.

The move affects about 10,000 patients who have an Anthem plan, Fore River said. The independent health care provider said in its letter that Anthem has proposed reimbursement rates that would not cover the cost of providing care. The change was scheduled to go into effect Monday for those with commercial plans, and Sept. 1 for those with Medicare Advantage.

“For more than four months, we have attempted to negotiate a contract renewal with Anthem, but unfortunately it has become clear that Anthem is not willing to reimburse Fore River Urology in a manner that would allow our practice to remain independent and be able to provide the high-quality, cost-efficient urological services that our patients deserve,” Fore River said in its letter to patients.


When the dispute between Anthem and MaineHealth became public in April, Gov. Janet Mills expressed her concern and urged the two sides to resolve their differences.

“Maine Medical Center is the largest tertiary care hospital in Maine and Anthem is the state’s largest insurer, serving more than 300,000 people, including state employees. Termination of the contract would significantly harm the cost of and access to care for Maine people who are Anthem customers, particularly in southern Maine, and seriously impact the operation of the health care market across the state,” Mills said. “Termination should be avoided at all costs.

“As both private parties negotiate the contract, I strongly urge them to put the interests of Maine people first, to resolve this issue in a timely way, and to reach an agreement that averts the need for such a drastic, damaging move.”


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