Well being look after 1000’s of Mainers in danger as deadline looms in insurance coverage combat
On the eve of their deadline for a brand new contract, a Catholic well being care system with hospitals in Maine and a significant insurer haven’t reached an settlement, which for months has left about 14,000 sufferers in limbo.
The contract between Covenant Well being, a household of Catholic well being care organizations in New England and a part of Pennsylvania, and insurer Anthem Blue Cross and Blue Protect expires Tuesday. As of Monday, variations had not been resolved, in line with the insurer.
Beginning Wednesday, Covenant Well being’s physicians, akin to these at St. Joseph Healthcare in Bangor and St. Mary’s Well being System in Lewiston, will depart the insurer’s community, mentioned Stephanie DuBois, spokesperson for Anthem Blue Cross and Blue Protect in Maine.
Failure to settle the dispute means Maine sufferers will face onerous choices. There are about 14,000 whose entry to providers is in danger.
A affected person wishing to stay with their longtime household drugs physician, as an example, will seemingly see a rise in co-payments and different prices. Some can’t afford the will increase, so that they’ll be pressured to seek out new suppliers and well being care amenities, or they could resolve to modify insurance coverage firms.
Anthem has inspired its members to schedule appointments with different suppliers of their space, together with Northern Mild Well being amenities in Bangor and Central Maine Healthcare amenities in Lewiston. In its newest replace, the insurer warned that prices “can go up dramatically” if Covenant leaves its community.
There are exceptions for Anthem members with advanced circumstances who’re receiving care at Covenant Well being amenities, DuBois mentioned. Sufferers who’re pregnant or terminally unwell, amongst others, can apply to proceed care at a location the place their physician is now not within the insurer’s community, although that is for a restricted time, usually 90 days, she mentioned.
The contract expiration can have no impact on emergency care, in line with each firms.
In a press release launched about 5:30 p.m. Monday, Covenant Well being wrote to sufferers it was dissatisfied to not have come to a decision with Anthem forward of the contract expiration, and it’s seemingly that the insurer will take away from its community Covenant’s 225 affiliated suppliers in Bangor and Lewiston.
“This isn’t the result that we wished or anticipated once we started conversations with Anthem Maine final October,” learn the assertion, supplied by spokesperson Karen Sullivan, noting it doesn’t mirror hours of negotiations and compromises provided.
In its June 1 replace, Covenant Well being claimed that it was a low-cost, high-quality supplier in Maine asking Anthem to pay it in keeping with market charges paid to different amenities and suppliers for related providers.
Anthem has prolonged gives to Covenant Well being to maintain the corporate in its community, together with will increase according to present and historic inflation, however these have been refused, DuBois mentioned.
Covenant Well being “continues to insist on double-digit charge will increase which are greater than thrice the speed of inflation,” she mentioned, which might place a burden on Maine employers and members.
Sullivan disputed the declare, saying that Covenant Well being has requested Anthem to “enhance our charges by a modest proportion in recognition of overwhelming will increase in workforce prices and inflationary pressures.”
Covenant Well being wrote in an earlier replace that it was dissatisfied with the phrases and charges that Anthem has provided, declaring that the insurer’s guardian firm, Elevance Well being, reported a primary quarter revenue of almost $2 billion this yr.
Anthem suggested sufferers with inquiries to name the member providers telephone quantity on the again of their ID card. Covenant Well being directed them to the Maine Bureau of Insurance coverage web site. Sufferers with questions particular to their circumstances ought to name 207-907-1682 in Bangor or 207-753-4995 in Lewiston.
