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Medical services for a large number of Mainers are in danger as cutoff time looms in the protection battle

Medical services for a large number of Mainers are in danger as cutoff time looms in the protection battle

A major insurer and a Catholic health care system with hospitals in Maine have not reached an agreement before the new contract deadline, putting approximately 14,000 patients in limbo for months.

Anthem Blue Cross and Blue Shield's contract with Covenant Health, a family of Catholic health care providers in New England and a portion of Pennsylvania, comes to an end on Tuesday. The insurer stated that disagreements had not been resolved as of Monday.

According to Stephanie DuBois, a spokesperson for Anthem Blue Cross and Blue Shield in Maine, Covenant Health's physicians, including those at St. Joseph Healthcare in Bangor and St. Mary's Health System in Lewiston, will leave the insurer's network starting on Wednesday.

Inability to resolve the debate implies Maine patients will confront hard choices. About 14,000 people are at risk of losing access to services.

A patient wishing to stay with their long-lasting family medication specialist, for example, will probably see an expansion in co-installments and different expenses. Some people won't be able to pay the increases, so they'll have to look for new health care providers and facilities or switch insurance companies.

Anthem has urged its members to make appointments with other providers in their area, such as the Bangor facilities of Northern Light Health and the Lewiston facilities of Central Maine Healthcare. The insurer stated in its most recent update that if Covenant leaves its network, costs "can go up dramatically."

According to DuBois, there are exceptions for Anthem members who are receiving care at Covenant Health facilities for complex conditions. She said that, for a limited time, typically 90 days, patients can apply to continue receiving care at a location where their doctor is no longer in the insurer's network, including those who are pregnant or in the final stages of their illness.

According to both organizations, emergency care will not be affected by the expiration of the contract.

It is likely that Anthem will remove Covenant Health's 225 affiliated providers in Bangor and Lewiston from its network, according to a statement released about 5:30 p.m. Monday. Covenant Health wrote to patients that it was disappointed that it could not reach a resolution with Anthem prior to the contract expiration.

The statement that was provided by spokesperson Karen Sullivan stated, "This is not the outcome that we wanted or anticipated when we began conversations with Anthem Maine last October," noting that it does not reflect the hours of negotiations and offered compromises.

Covenant Health said in its update on June 1 that it was a low-cost, high-quality provider in Maine and asked Anthem to pay it a rate that was comparable to what other facilities and providers in the market paid for services of a similar nature.

According to DuBois, Anthem made Covenant Health a number of offers to keep the company in its network, including increases based on both current and historical inflation, but the company turned them down.

She stated that Covenant Health "continues to insist on double-digit rate increases that are more than three times the rate of inflation," putting a strain on members and employers in Maine.

Sullivan questioned the case, saying that Contract Wellbeing has requested that Song of Praise "increment our rates by an unobtrusive rate in acknowledgment of overpowering expansions in labor force costs and inflationary tensions."

In a previous update, Covenant Health expressed its dissatisfaction with Anthem's terms and rates, pointing out that the insurer's parent company, Elevance Health, made a profit of nearly $2 billion in the first quarter of this year.

Anthem advised patients to call the member services number on the back of their ID cards if they had questions. They were directed by Covenant Health to the website of the Maine Bureau of Insurance. Call 207-753-4995 in Lewiston or 207-907-1682 in Bangor if you have questions about your situation.

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