Covenant Health and Anthem Blue Cross are still at odds even though their insurance agreement has expired. Beginning on July 5, Anthem patients using St. Mary’s in Lewiston and St. Joseph Hospital in Bangor will experience changes to their coverage. With Anthem offering reasonable price increases, the pricing structure of Covenant Health is the main problem. By keeping costs low for patients, Covenant aims to provide providers with fair compensation. Anthem refers clients to additional in-network medical professionals and is evaluating cases for continued care at Covenant Health facilities.
Covenant Health and Anthem Blue Cross are still in disagreement despite their insurance contract expiring. Starting from July 5, patients who are covered by Anthem Blue Cross/Blue Shield and receive treatment at St. Joseph Hospital in Bangor and St. Mary’s in Lewiston will experience changes in their coverage.
Covenant Health, the operator of these two hospitals, has been engaged in negotiations with Anthem for a new in-network contract to replace the expired one. However, no agreement has been reached so far.
The main point of contention, according to the insurance company, lies in Covenant Health’s pricing. Anthem claims to have made reasonable offers for price increases, but Covenant insists on setting prices that ensure fair reimbursement for providers and hospitals while remaining affordable for patients.
Covenant Health has sent an urgent letter to its patients who use Anthem insurance, providing a hotline for any questions or concerns. Anthem has also published relevant information on its website.
In a statement issued by Covenant Health, it was announced that starting from July 5, 2023, St. Mary’s Health System in Lewiston and St. Joseph Healthcare in Bangor, along with their associated providers, will no longer be considered in-network for Anthem members. However, this change does not affect the ability of patients to seek care in the emergency departments of these hospitals, as emergency care is always considered in-network. The emergency departments will remain open and available to those in need.
In certain cases where continuity of care is required, patients with specific healthcare conditions may still be considered in-network. Continuity of care is regulated by state and federal laws and encompasses various situations such as cancer care, post-surgical follow-up, behavioral health treatments, and other conditions where seamless care transitioning is crucial for patients.
As an out-of-network patient, individuals may choose to continue seeing Covenant Health providers and utilizing their hospitals, but Anthem will likely require them to use out-of-network benefit options.
A spokesperson from Anthem Blue Cross and Blue Shield in Maine stated that Covenant Health has the ability to withdraw their termination before the coverage is disrupted for Anthem members on July 5. Anthem has extended offers to Covenant Health to remain in-network, including reasonable increases aligned with current and historical inflation rates. They express their commitment to reaching an agreement in good faith as soon as possible. However, Covenant Health’s insistence on double-digit rate increases, which are more than three times the rate of inflation, has led to the rejection of Anthem’s offers to maintain affordable care. Anthem cannot accept such substantial increases as they would impose a significant cost burden on employers and members in Maine.
To ensure that members have access to necessary care beyond July 5, Anthem is actively directing them to other high-quality, in-network providers in the area, such as Central Maine Healthcare in Lewiston and Northern Light Health in Bangor. Anthem offers a broad network of hospitals and physicians, including all other hospitals in Maine under most health plans. They are also collaborating with providers and Anthem members to schedule elective procedures at alternative hospitals or facilities within their network. Additionally, measures are in place to review cases for members who require ongoing care at a Covenant Health facility for a certain period.