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Maine Hospitals Excluded from Anthem Plan Cry Foul at Public Hearing
06/28/2013   Reported By: Patty B. Wight

Maine Medical Center's parent company, MaineHealth, has partnered with Anthem to offer a new online insurance product as part of the Affordable Care Act. The plan was under scrutiny at a public hearing at the Bureau of Insurance today, because it excludes six hospitals. Officials from those excluded hospitals are crying foul, saying if the proposal is approved, it will force thousands of patients to switch doctors. Patty Wight has more.

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Hospitals Excluded from Anthem Plan Cry Foul at Pu Listen
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Julie Rioux (left) and Brenda Weeks fear they will have to switch doctors under Anthem and MaineHealth's insurance plan.

These new insurance "products," as they're called, are targeted to individuals and small groups - the people who currently either don't have insurance or who pay a lot of money for it. The details of Anthem's proposal, including the cost, are under wraps. But one thing is clear - 32 of Maine's 38 hospitals are accepted providers.

"It's a very broad, it's a very deep, it's a very experienced network that we're affiliating with, and we're very confident that this more than meets the state standards for adequacy," says Chris Dugan of Anthem.

All of MaineHealth's hospitals and affiliates are included, as are Eastern Maine Healthcare's. Central Maine Healthcare's three hospitals are out, as well as Parkview, York, and Mercy Hospitals. Dugan says it's nothing personal - it's about costs.

"In this instance, we have chosen a network for this one particular product that services a very specific group of our members, because we feel it offers the ability to have affordable choices for some of these new plans that are coming out," he says.

It's called a narrow provider network, where insurance companies strike a deal with select hospitals who agree to lower their payments in anticipation of gaining new patients. But Central Maine Healthcare spokesman Chuck Gill says there's more to Anthem's narrow network than affordability.

"Every hospital from Waterville north is in it. Only when you get south of Waterville do you start having this narrowness occur," Gill says, "and it just happens to be those hospitals that have opposed MaineHealth in the past."

Gill says Central Maine Health has over 300 primary care physicans who serve 18 communities. But under Anthem's plan, he says thousands of patients will be forced to switch doctors.

"We're having a hearing today for two reasons: a grab for marketshare by MaineHealth; and some type of discounting that Anthem thinks they've achieved," Gill says. "What they've achieved is a lot of anger on the part of everyday Mainers."

"They're about to turn my world upside down by what they're doing," says Brenda Weeks. Weeks has had an Anthem insurance policy for 29 years. She has multiple sclerosis, and has always received care from Central Maine Healthcare.

"I've worked for 20-plus years since the onset of the chronic illness to get a healthcare team to best meet my needs, and I am where I am today because of the care that I receive," Weeks says.

Julie Rioux from Minot has a small group Anthem plan through her husband's employer. She says she's worried, not only about losing a trusted family doctor, but about logistics. "I don't want to have to travel - I don't want to travel to Portland with a sick child," Rioux says.

Chris Dugan from Anthem says customers like Rioux will only have to switch if her husband's employer decides to purchase a plan on the exchange. As for customers like Brenda Weeks, Dugan says Anthem will grandfather individual plans purchased before March 23, 2010. That accounts for 50 percent of the 18,000 current customers with individual plans.

Weeks says she appreciates the gesture, but isn't convinced it will last. "I don't have trust that they would just continue on their merry way and say, 'You're grandfathered, you're fine, nothing's ever going to change.'"

At the hearing, Anthem officials repeatedly emphasized that they are merely presenting customers with a choice, and that in this network, the maximum distance between a patient and primary care provider is 30 minutes. For a specialist, it's 60 minutes.

Now it's up to the Bureau of Insurance to decide whether that's adequate for the Maine insurance marketplace.

Photo: Patty Wight

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