About 30,000 residents in Maine face potential disruptions to their healthcare access as a critical contract negotiation between Northern Light Health and Anthem Insurance remains unresolved. With a deadline fast approaching, both organizations indicated on Friday evening that they were far from reaching an agreement on reimbursement rates, a matter that has been under discussion for several months.
Originally set for October 1, the deadline for negotiating an agreement was extended to the midnight of the upcoming Saturday, November 1. Should the two entities fail to come to terms by this time, Northern Light’s primary care physicians, alongside specialists and nurses, will be classified as out-of-network for Anthem customers, creating considerable concern for those who rely on their services.
Maine state officials have emphasized that residents have some legal protections, even in the event of a contract failure. Maine’s insurance code mandates that health plans must guarantee “reasonable access” to medical care, although the term “reasonable access” is not explicitly defined in state statutes. Additionally, continuity-of-care laws exist to facilitate a smooth transition for patients seeking to continue treatments with their current providers, even if those providers become out-of-network.
Bob Carey, superintendent of the Maine Bureau of Insurance, provided examples of these continuity-of-care protections. He noted that patients, especially those in critical health situations, would not be forced to switch providers abruptly. For instance, individuals nearing the delivery of a baby or those undergoing ongoing cancer treatment will be allowed to continue receiving care from their existing providers without incurring higher out-of-pocket expenses.
The imminent deadline specifically impacts outpatient services offered by Northern Light, such as annual physicals, which are utilized by Anthem customers under both individual and employer-sponsored plans. However, Anthem Medicare customers will have coverage with Northern Light until the end of the year.
Emergency care regulations ensure that all Anthem customers will still have access to in-network services under federal law. Additionally, another deadline looms on December 31, which will see Northern Light Hospitals go out-of-network. Carey explained that while in-patient care at Northern Light facilities may be treated as in-network during this period, services rendered during those hospital stays will be billed at the in-network rate.
In light of the ongoing negotiations, Anthem has launched a dedicated website offering updates and guidance to affected customers. The Maine Bureau of Insurance has also advised individuals holding Anthem plans to contact the number on the back of their insurance card prior to visiting any Northern Light provider to clarify coverage specifics and potential costs.
As the deadline approaches, Maine residents are left in uncertainty about their healthcare options and are encouraged to remain informed about the situation as it develops.
