MaineHealth and Anthem settle long-running contract dispute

Maine's two health care heavyweights, MaineHealth and Anthem, have settled a long-running contract dispute that threatened to upend health markets in the state.

Patients with Anthem health insurance will continue to receive in-network care at Maine Medical Center in Portland after the state's biggest insurer and largest hospital network signed a two-year contract, according to statements released Wednesday evening by both parties. Had the agreement not been signed, Maine Med would have been out-of-network for Anthem patients starting in January, forcing tens of thousands of Mainers to pay higher fees to the hospital or find other medical providers.

"MaineHealth has an unwavering focus on our patients and their families in order to deliver on our vision of working together so our communities are the healthiest in America," Dr. Andy Mueller, CEO of MaineHealth, said in a written statement. "Our agreement with Anthem provides both of us with the opportunity to reaffirm our relationship as we work to improve the health and well-being of our communities."

Denise McDonough, president of Anthem Blue Cross and Blue Shield in Maine, said in a written statement that "continuing our partnership with MaineHealth is important to maintaining and improving access to healthcare at Maine Medical Center. We value the relationships we have with the providers in our network, which are important to fulfilling our mission of improving the lives of the people we serve in communities across Maine."

The two parties decided details of the contract would be confidential, MaineHealth spokesperson John Porter said when asked Wednesday night for details about how the agreement was reached.

"I can say the turning point in the negotiations was when the people involved in the negotiations made the decision to focus on building a better relationship going forward and not to keep arguing about the issues in the past," Porter said. "Really the whole point of this agreement is to craft a positive relationship going forward."

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Stephanie DuBois, a spokesperson for Anthem, also declined to discuss details of the settlement agreement. "But both Anthem and MaineHealth have included key elements that made this agreement and our continued partnership possible," DuBois said in an email.

MaineHealth had threatened to remove Maine Med from Anthem's network, starting in January, over financial disagreements. Maine Med is the largest hospital in MaineHealth's statewide network.

Anthem is the largest insurer in Maine, with 300,000 members statewide, representing 54 percent of Maine's health insurance market. Anthem's parent company, Indianapolis-based Elevance Health, is one of the nation's largest health insurance companies, providing Anthem Blue Cross and Blue Shield plans in 14 states, including Maine.

About 150,000 Maine Med patients have used Anthem insurance in recent years. If Maine Med had no longer been in-network for Anthem members, it could have caused major disruptions in the health care market in the state. Some patients would have had to seek services at other hospitals, or been socked with expensive out-of-network charges to receive care at the Portland hospital.

PUBLIC NATURE OF DISPUTE UNUSUAL

"The agreement is a good thing for the people of Maine because it means (Anthem members) will continue to have all the varied and qualified experts available to them at Maine Med," said Mitchell Stein, an independent health policy consultant.

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"But it is unfortunate that it took this public back-and-forth. I know people were concerned they would have to switch providers or insurance. All these things can be very disruptive and disrupt care, so at the end of the day it's very positive that they've reached an agreement."

Stein said the public nature of the negotiations between MaineHealth and Anthem was unusual and highlight what is usually a behind-the-scenes process. "While this directly only impacts the Anthem network, it is reflective of the whole healthcare marketplace that these negotiations are always taking place between insurance companies and provider groups," he said. "The constant back-and-forth with all this does mean networks aren't constant and things can end up changing for people all the time."

In the case of Anthem and MaineHealth, the dispute was 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 accused Anthem of shortchanging its health care providers by denying payments for services rendered. Anthem said MaineHealth routinely overcharges for medications. Both sides 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.

MaineHealth announced the contract impasse in April, and the two sides traded barbs over the spring and summer, but there were signs that negotiations were bearing fruit in early August.

Gov. Janet Mills, who had encouraged the sides to come to terms, welcomed the announcement that an agreement had been reached.

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"I am pleased that both parties were able to resolve their differences, as I urged, to avert such a drastic and damaging move," Mills said in an email Wednesday night.

SOME FALLOUT

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

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 has been some fallout from disputes with Anthem in Maine. 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.

Staff Writer Rachel Ohm contributed to this report.