Main Content
Member News

Updates About Maine Medical Center

May 03, 2022

Here’s What’s Happening

MaineHealth recently announced its intent to remove Maine Medical Center in Portland from our care provider network at the end of the year. While we have maintained a strong working relationship with MaineHealth for decades, in recent years we have been in discussions regarding overcharging for services provided at Maine Medical Center. Practices like these ultimately drive higher healthcare costs in the form of higher premiums and out-of-pocket costs for members. What’s more, MaineHealth is now also requesting double-digit rate increases that will push costs even higher. This is unsustainable for Mainers, who already pay some of the highest healthcare costs in the nation.

Anthem Blue Cross and Blue Shield is committed to providing our members access to high quality, outcomes-driven healthcare. Our work also centers on ensuring that care is affordable. We have a responsibility to address the challenges of rising healthcare costs on behalf of those we serve.

Unfortunately, following months of discussions, MaineHealth’s public announcement of its intention to pull the state’s largest hospital from our network has caused concern and confusion. We are disappointed that consumers are being brought into the middle of this, but are confident that if MaineHealth joins us in putting the needs of healthcare consumers first, we can come to a decision that is agreeable to both parties.

We strongly believe that a continued partnership with MaineHealth is important to providing Mainers with access to high-quality in-network care.

Learn more from Anthem President Denise McDonough’s op-ed in the Portland Press Herald

 
Anthem MaineHealth Graphic
 
 

Frequently Asked Questions

Q: Who will be impacted by MaineHealth’s announcement?

Please note, there is no immediate change to healthcare coverage for our members as Maine Medical Center remains in our care provider network through the end of the year. If Maine Medical Center leaves Anthem’s network, any Anthem member who is receiving healthcare services or will seek services after December 31, 2022, from Maine Medical Center will be impacted.

One exception: Anthem members in New Hampshire on a New Hampshire Pathway plan will not be impacted by this potential termination as Anthem Blue Cross and Blue Shield in New Hampshire contracts separately with Maine Medical Center for Pathway only.

At this point, it is unclear if MaineHealth’s actions will impact Medicare Advantage members, including those with Anthem I MaineHealth Medicare Advantage plans. Please check this site for updates.

 

Q: Which hospitals/facilities are impacted by MaineHealth’s announcement?

At this time, only Maine Medical Center in Portland is impacted by MaineHealth’s announcement; no other hospitals, facilities, or providers are affected.

 

Q: Are you concerned Maine Medical Center will eventually leave Anthem’s network?

We are committed to resolving the issues with MaineHealth. It is our hope MaineHealth will honor its commitments to Anthem, our members, and the people of Maine.

While it is unfortunate that MaineHealth has unnecessarily alarmed consumers with its threat to pull Maine Medical Center from Anthem’s provider network, we remain confident that these issues will be resolved and our longstanding partnership will continue uninterrupted. As we work tirelessly toward a mutual resolution, Anthem will keep our customers, our members, and our provider partners informed and up to date on our progress.

 

Q: Wasn’t there an issue with MaineHealth overcharging Anthem members?

In 2018, we discovered through a routine audit overbilling for anesthesia and operating room services at Maine Medical Center. As a result of an investigation, MaineHealth eventually acknowledged the overcharging and issued refunds to our members amounting to nearly $20 million. If it were not for our internal audits – a system of checks and balances to protect our members – these overcharges may never have been discovered.

Unfortunately, we find ourselves in a similar situation, where through a routine audit, it was discovered that MaineHealth has once again overcharged Maine consumers and charged them for services they shouldn’t have, which we believe totals millions of dollars. Disputing such charges is at the heart of the current dispute with MaineHealth.

 

Q: How will members currently being treated for ongoing conditions such as cancer or other conditions that require ongoing care be affected?

We remain ready and willing to move past these issues and work with MaineHealth to ensure Maine Medical Center remains in network. In the event that does not occur, it is important to remember that Maine Medical Center will remain in the Anthem network through December 31, 2022. Anthem will make sure members who need ongoing care continue to have access to needed care beyond December 31, 2022.

 

Q: What should members do when they need emergency medical care from Maine Medical Center?

It is important to remember that Maine Medical Center will remain in the Anthem network through at least December 31, 2022. A hospital’s emergency medical services do not require pre-authorization, regardless of where they are delivered. Anyone in need of emergency care should go to the nearest emergency room or call 9-1-1. Coverage will be provided according to the member’s policy benefits and is subject to in-network cost shares.

 

Q: What if I have further questions?

Please check this site for updates on our work to resolve issues with Maine Medical Center or call the Member Services number on the back of your Anthem ID card.

1 https://ldi.upenn.edu/wp-content/uploads/archive/pdf/Penn%20LDI%20and%20US%20of%20Care%20Cost%20Burden%20Brief_Final.pdf

2 https://www.rand.org/pubs/research_reports/RR4394.html