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Anthem-MaineHealth Network Plan Wins Initial Approval - With Conditions
07/25/2013   Reported By: Patty B. Wight

Anthem Blue Cross Blue Shield received approval today from the Maine Bureau of Insurance to offer a new insurance product under the federal Affordable Care Act. Anthem partnered with MaineHealth to create insurance plans for the individual and small group market. But as Patty Wight reports, it excludes six state hospitals - including the Central Maine Health Care network.

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Anthem-MaineHealth Network Plan Wins Initial Appro Listen

The new health insurance product is what's called a "narrow provider network." Anthem had to prove to state regulators that this narrow network provides customers reasonable access to health care, which, according to Maine standards, requires a maximum travel distance of 30 minutes between a patient and primary care provide, and 60 minutes for a specialist.

Though the answer from the Maine Bureau of Insurance is "Yes," not everyone agrees with that decision.

"So, it may be reasonable - meet the really low bar, I guess, of reasonable access to health care services," says Chuck Gill, a spokesman for Central Maine Health Care.

Gill says the plan only affects those in the southern part of the state, where hundreds of doctors from six hospitals - including Parkview, York and Mercy - are excluded from the network.

"Anthem made a bad decision excluding our system, and I think they made a bad decision overall excluding six hospitals. They should have gone the same route in southern Maine as they did in northern Maine, because we're one Maine."

Anthem has said it intends to switch some of its current customers onto the new plans, a prospect which has created anxiety in some patients.

But Maine Superintendent of Insurance Eric Cioppa wrote in his decision that, although he is permitting Anthem to offer narrow network plans, it does not necessarily mean he will permit Anthem to move its current customer base into these plans. That decision will be made after a Sept. 9 hearing, where Anthem will have to demonstrate that such a switch offers a corresponding benefit to customers, "presumably, lower rates," Cioppa says.

In a written statement, Anthem spokesman Chris Dugan said the decision is good news for Maine families, and that Anthem's collaboration with MaineHealth and other select providers will provide more affordable insurance options.

The plan still requires federal approval before it can be offered when the new online health exchanges open Oct. 1. Central Maine Health Care has 30 days to decide whether to appeal the decision.


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