A Catholic health care system with hospitals in Maine and a major insurance company have not settled their differences about a month before their contract ends, putting more than 14,000 patients and their access to services at risk.
Covenant Health, a family of Catholic health care organizations in New England and part of Pennsylvania, and insurer Anthem Blue Cross and Blue Shield have been negotiating since October 2022. There was still no agreement Friday between the insurer and St. Joseph Healthcare in Bangor or St. Mary’s Health System in Lewiston, according to spokespeople from both companies.
The contract expires July 4, which is the last day Covenant Health’s facilities and medical professionals will be in Anthem’s network, said Stephanie DuBois, spokesperson for Anthem Blue Cross and Blue Shield in Maine.
The insurer has begun directing members to other health care providers, which offer a wide range of services often at lower costs, she said. Another spokesperson said this might include Northern Light Eastern Maine Medical Center in Bangor and Central Maine Medical Center in Lewiston, among other places.
Anthem and Covenant Health have argued that their focus is to maintain quality, affordable health services for patients and point to each other as impeding that in negotiations. This leaves more than 14,000 Maine patients in a tough spot, likely having to change their medical insurance or medical caregivers.
There were 295,704 people enrolled with the six largest health insurance companies in Maine as of Dec. 31, 2022, according to figures that insurers must provide annually to the Bureau of Insurance. Of the insurers listed, Anthem had 156,891 enrollees, or 53 percent.
One St. Joseph Healthcare patient pointed out how health care and insurance can be confusing for many to navigate, and this disagreement further muddles the process. Some patients said they were concerned about what will happen to their relationships with doctors and familiar services and wondered how to prepare in case Anthem and Covenant Health cannot come to an agreement.
“I believe this will get reconciled,” said Jann Jones, who is a Glenburn resident and St. Joseph Healthcare patient. “But what does this do to the trust in your hospital and the trust in your insurance company who you rely on to be there? This shakes people.”
Earlier this month, Jones received a letter from Anthem Blue Cross and Blue Shield’s federal employee program, dated May 4, which left her stunned, she said. The insurer would continue to pay for covered benefits until 90 days from when the letter was written, or Aug. 2, according to the letter. It also outlined information for members under various plans.
Jones and her husband, Chris, are enrolled in Medicare and use Anthem as their supplemental insurance.
A Covenant Health customer service representative whom Jones spoke with May 15 was not aware of the notice sent to patients and could not answer her questions, Jones said. The representative seemed confused, pointing out to Jones that she can’t do that until the open enrollment period in December, she said.
“You’ve got all these people hanging,” she said, referring to the potential gaps in coverage.
After July 4, for a limited time, Anthem members may continue to receive care with their provider, even if that person leaves the network, according to the insurer. That applies to patients who are pregnant, terminally ill, scheduled for nonelective surgery by their current doctor, in a hospital or inpatient facility and those in treatment for a complex condition.
Anthem has offered “reasonable increases over the next several years” that address the rising cost of providing health care services, while “Covenant Health is demanding double-digit rate increases that are more than three times the rate of inflation,” Anthem spokesperson DuBois said in a statement, though she did not provide figures.
Maine consumers and businesses cannot afford the increases, she said.
Covenant Health has remained focused on protecting patients’ relationships with their physicians, spokesperson Karen Sullivan said in a statement. Covenant wants to structure an agreement that gives fair reimbursement to providers and hospitals while also offering services at an affordable rate, she said.
On the Bangor and Lewiston hospitals’ websites, Covenant Health wrote in its latest update that it was disappointed with the terms and rates that Anthem has offered, which was only deepened by the insurer’s recent financial performance.
Anthem’s parent company, Elevance Health, reported a first quarter profit of nearly $2 billion this year and added more than 1 million new members.
“As with all potential provider terminations, the [Maine Education Association] Benefits Trust understands that members will be concerned about continuity of care,” the organization, which represents public school employees, said on its website in early May. “We recognize that provider contract disputes create unrest and uncertainty for our members.”
The Maine Municipal Employees Health Trust, which serves municipal and county governments, also notified its members, expressing concern about the potential lack of access to providers and hospitals.
Jones has scheduled an appointment with an internist at Northern Light Eastern Maine Medical Center in the event that Anthem and Covenant Health do not resolve their differences, though she’ll have to wait until October to be seen.
A small number of Bangor providers accepting new patients were available during her online search, Jones said, and she specifically wanted an internist rather than a family medicine provider.
Anthem and Covenant Health, in separate statements, emphasized their commitment to patients and responsibility to keep health care affordable.
Jones sees a reinstatement of services for which patients are paying, with no changes in coverage, as the ideal outcome.
“This big ball of wax here potentially has ramifications for so many people,” she said, particularly disadvantaged Mainers. “Hard choices are going to be made. [For some] they are going to include not going to the doctor, not getting a mammogram, not getting bloodwork done because they can’t afford it.”
