Dispute between MaineHealth and Anthem frustrates Maine unions

Both the Maine Education Association Benefits Trust and the Maine Service Employees Association have reached out to both sides, urging them to reach a resolution.

PORTLAND, Maine — Unions representing tens of thousands of people are expressing frustration over MaineHealth’s announcement that it will no longer accept Anthem insurance at Maine Medical Center in Portland beginning in 2023.

On Wednesday, MaineHealth CEO Andrew Mueller said the health system’s flagship hospital, Maine Medical Center in Portland, will stop taking Anthem as an in-network provider on January 1, 2023.

Mueller said Anthem owes MaineHealth $70 million in unpaid claims and is withholding an additional $13 million in disputed charges. Anthem said the $13 million was due to MaineHealth overcharging for the services.

A spokesperson for Anthem said a routine review in 2018 found overcharging by Maine Medical Center for anesthesia and operating room services.

“MaineHealth eventually relented and refunded our members the amount they overcharged. These overcharges totaled nearly $20 million for our members. Without our audits, these overcharges may never have discovered,” Stephanie DuBois, public relations director for Anthem Blue Cross and Blue Shield in Maine, wrote in an emailed statement.

According to Governor Janet Mills’ office, Anthem covers approximately 300,000 people in Maine. It’s Maine’s largest insurer.

On Thursday, two of Maine’s largest unions called the contract dispute “outrageous” and “very concerning.”

The Maine Service Employees Association has more than 13,000 members who work in city and county governments, the three branches of Maine state government and elsewhere. State of Maine employees currently have Anthem for their insurance.

MSEA President Dean Staffieri said in an emailed statement:

“We are extremely concerned about Maine Medical Center’s announcement that they will be removing Anthem patients from network health coverage beginning January 1, 2023. This would be outrageous for workers in Maine, especially those in southern Maine and those who need specialized care. that Maine Medical Center provides, to pay significantly more for their health care as a result of this corporate dispute. Hundreds of thousands of workers across Maine who are already struggling to make ends meet are now having to wonder if they will be able to afford the care they need. We urge the CEOs of Anthem and Maine Health to start putting themselves in our members’ shoes and act quickly to resolve their dispute. We have begun discussing the potential impact on our members with Anthem and the State. In the meantime, we are exploring all available options and will update our members as we learn more.

Staffieri declined an interview on camera.

The Maine Education Association, which represents teachers, also has a Benefits Trust (MEABT). It recommends about 68,000 members.

MEABT Executive Director Jennifer Kent said in an email:

“On behalf of our members, we are very concerned about Maine Medical Center’s notice of intent to terminate its provider network contract with Anthem at the end of the year. We have been in contact with both parties and have expressed our concerns and continue to encourage both parties to resolve their differences and resolve this dispute Termination of this contract would be unprecedented and detrimental not only to our members, but to a large percentage of Maine residents, in general. We continue to hope that both parties will put the best interests of their patients and members first and do their best to reach an agreement and keep Maine Medical Center in the Anthem network.”

In a statement posted on its website, MEABT said it received notice of termination of the contract from MMC moments before it was released to the press.

“We can only assume that MMC’s lack of notice was intentional,” the statement said. “The Trust and its advisors are monitoring this situation and will also be working on contingency plans in the event that an agreement cannot be reached. The impact of MMC leaving the Anthem network would have a huge impact on our members and a large percentage residents of Maine, in general.

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