State to hold public comment session on Anthem narrow network plan

The Maine Bureau of Insurance will hold a public comment session Thursday on Anthem Blue Cross and Blue Shield's proposal to move a number of its current individual policyholders into a narrow network plan that strictly limits which hospitals and doctors they can use.

In central Maine, Central Maine Medical Center in Lewiston, Bridgton Hospital, Rumford Hospital and Parkview Adventist Medical Center in Brunswick would be excluded from that network. St. Mary's Regional Medical Center in Lewiston, Franklin Memorial Hospital in Farmington, Mid Coast Hospital in Brunswick and Stephens Memorial Hospital in Norway would be included.

The comment session will begin at 5 p.m. and will be held in Kirk Hall at Central Maine Community College in Auburn.

Following that session, at 6 p.m., the bureau will hold a public information session on the Affordable Care Act.

Anthem's plan represents a partnership between the largest health insurance company in the state and MaineHealth, the largest health-care organization in the state. All MaineHealth hospitals and affiliates are in the plan. Six Maine hospitals and their affiliates, all in some way competitors with MaineHealth or its affiliates, are out.

Anthem first proposed its narrow network for the upcoming Affordable Care Act health insurance marketplace, also known as an exchange. Individuals can receive a federal subsidy to help pay for their insurance if they buy from the marketplace and if they make up to 400 percent of the federal poverty level. 

The state approved that plan last month. The plan must still win approval from the federal Centers for Medicare and Medicaid Services. However, the federal government is expected to accept the state's judgment on Anthem's network.

Anthem is now asking to move a number of its current individual policyholders to the same narrow network. Thursday's public hearing will address that proposal.

Grandfathered plans — those purchased before March 2010 — could be exempt. About half of Anthem's 17,500 individual policyholders are in a grandfathered plan. 

The narrow network has proven controversial, with Lewiston Mayor Robert Macdonald and Central Maine Healthcare publicly opposing it. 

"This anti-competitive plan is designed to make it more difficult for Anthem patients to seek local medical care and services, will force many to change physicians, and will negatively impact Central Maine Healthcare, one of our region's largest employers," Macdonald said in a statement released earlier this month. "This proposal is bad for patients, bad for CMMC and bad for the entire Lewiston-Auburn region."

Macdonald said Friday that he will attend the hearing.

"I was elected mayor here to fight for these people and that's what I'm going to do. I'm not going to sit by and just let this thing happen," he said.

Central Maine Healthcare owns three of the hospitals not in the network and has a relationship with a fourth. It's created ads and a website, www.keepcarelocal.com, to urge people to oppose Anthem's plan. CMHC spokesman Chuck Gill said he receives calls and emails every day from Mainers concerned about the proposed network.

"People are concerned, not only for the issue at hand, but concerned about this whole idea that insurance companies can just eliminate hundreds of doctors and six hospitals, and what that means for the future," Gill said.

A formal public hearing will be held Sept. 9 at the Burton M. Cross State Office Building in Augusta. Presentations by parties to the proceeding will begin at 9 a.m. Public comment will also be allowed during that hearing. 

ltice@sunjournal.com

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Comments

Tobey Johnson's picture

An early look

Well, for those who wanted to know what Obama-Care will be like, here ya go. This is going to be a mess.

Jason Theriault's picture

This has nothing to do with Obama

This has nothing to do with Obama and everything to do with profits.

Anthem is going to see a majority of it's policy holders are going to be in areas that Maine Med is dominant, and if they can get a sweetheart deal by screwing over Central Maine Med, they will. Now the question is will the bureau of insurance sign off, which I bet they will because LePage and his crew don't want to do anything to regulate any sort of business activity.

So hopefully, many businesses in the region will look to Maine Community Health Options instead of Anthem.

Tobey Johnson's picture

well, this in particular may

well, this in particular may have nothing to do with Obamacare, yes, I will agree, but this is going to be what ObamaCare will be like....just a big mess on where and when you can go see a doctor and instead of seeing the one you've had for 10-20 years, you'll have to go see someone else and develop a whole new relationship with that one. If its not broke, don't fix it....Health Care was not completely broken, it needs tweaking, not an overhaul like they are doing.
I hope Gov. LePage does the right thing here for everyone, this will hurt CMMC more than help anyone. They have a lot of offices and patients that count on their treatment and to have an insurance company do this, is wrong. Not just wrong but damn near criminal in my opinion. Greed is a dangerous and powerful feeling, makes one loose their mind and soul.

Jason Theriault's picture

Well, actually.....

Actually, this issue does have a connection to the ACA.

Because the ACA directed CMS(Centers for Medicare and Medicaid Services) to create the Consumer Operated and Oriented Plan (CO-OP) Program, which lead to the creation of of the Maine Community Health Options CO-OP. So the only real check on Anthem giving central Maine the finger is an ACA program.

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Insurance-Programs/Co...

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