Important Update About Covenant Health in Maine

May 25, 2023

Anthem Blue Cross and Blue Shield has been negotiating in good faith with Covenant Health in an effort to reach a new agreement that keeps St. Mary’s Regional Medical Center in Lewiston, St. Joseph Hospital in Bangor, and Covenant Health’s physicians, providers, and other facilities in Maine in our care provider network.

Because Covenant Health insists on large rate increases for consumers that are three times the current rate of inflation, we have not yet been able to come to an agreement. Unless an agreement can be reached, Covenant Health facilities and physicians will leave our network effective July 5, 2023.

Why is this happening?
The negotiations center around our goal of maintaining access to quality, affordable healthcare for our members, and to minimize increased healthcare costs for Maine families already struggling with high inflation. We understand Maine health systems – like other health systems and businesses across the country – are experiencing economic challenges.

However, Covenant Health wants to raise prices for our members despite currently being paid in line with other area health systems. These cost increases would place an increased financial burden on Maine consumers and their families, and on our community’s employers – many of whom directly pay their employees’ medical bills. Anthem has offered reasonable and competitive increases that Covenant Health has refused.

Anthem will continue to work in good faith to reach a new contract with Covenant Health. Please continue to check this site for updates.

Frequently Asked Questions

Which hospitals/facilities are included in this negotiation?

• St. Mary’s Regional Medical Center in Lewiston, Maine
• St. Joseph Hospital in Bangor, Maine
• St. Mary’s d’Youville Pavilion in Lewiston, Maine
• Home Health and Hospice of St. Joseph in Bangor, Maine
• St. Joseph Infusion Center in Bangor, Maine
• All physicians and providers at the above facilities

NOTE: Community Clinical Services (CCS) is not included in this termination and remains in network.

Who will be impacted by Covenant Health’s action?
It is important to note that there is no immediate change to healthcare coverage as St. Mary’s Regional Medical Center in Lewiston, St. Joseph Hospital in Bangor, and Covenant Health’s physicians, providers, and other facilities in Maine remain in network through July 4, 2023.

If Covenant Health’s Maine hospitals, physicians, providers, and facilities leave Anthem’s network, Anthem members who are receiving healthcare services or will seek services on or after July 5 will be impacted. This includes commercial, Medicare Advantage, and Federal Employee Program (FEP) members.

NOTE: Medicare Supplement members are not impacted. Maine Medicare Supplement members can visit any provider/hospital that accepts Medicare.

What should I do if I need emergency medical care from a Covenant Health facility?
It is important to remember that Covenant Health hospitals remain in the Anthem network through July 4, 2023. 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 your policy benefits and is subject to in-network cost shares.

What if I need care from a Covenant Health facility or doctor after July 4?
We remain ready and willing to work with Covenant Health to ensure its hospitals, physicians, providers, and other facilities remain in network. In the event that does not occur, it is important to remember that Covenant Health’s hospitals, physicians, providers, and other facilities will remain in the Anthem network through July 4, 2023. Anthem will make sure members who need ongoing hospital care continue to have access to needed care.

Members may continue to receive in-network level of benefits for covered services with a provider who is leaving our network, for a limited time, if they are receiving certain types of care:

• In treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment to avoid death or permanent harm. It can also be an ongoing (chronic) illness that is life-threatening or potentially disabling and requires specialized care over a long period of time.
• In a hospital or other inpatient facility.
• Scheduled for nonelective surgery by their current doctor, including post-operative care for the surgery.
• Pregnant.
• Terminally ill.

Members can review their plan documents for information about Continuity of Care by logging in to anthem.com (under My Plan, go to the medical benefits page).

How can I receive authorization to continue my care with Covenant Health after July 4?
Members can obtain a Continuity of Care form on anthem.com. Alternatively, you may call Anthem’s Member Services number on the back of your ID card to request the form.

What if I have further questions? 
Please check this site for updates on our work to resolve issues with Covenant Health, or call the Member Services number on the back of your Anthem ID card.