Anthem Blue Cross and Blue Shield had not yet decided Tuesday whether it would appeal a Maine Bureau of Insurance ruling that prevents the health insurance company from moving thousands of policyholders into a so-called “narrow network” plan, limiting which doctors and hospitals they can use.
“While we continue to believe that our proposal to replace existing plans with new plans that offered a network with reasonable and comprehensive access to services at a premium that would have been 12 percent lower is in the best interest of our members, we are in the process of reviewing the ruling to determine next steps,” Anthem spokesman Chris Dugan said.
He declined to comment further.
Insurance Bureau Superintendent Eric Cioppa issued his ruling Friday. Anthem can appeal the decision through the Superior Court within 30 days.
In his ruling, Cioppa told Anthem to promptly submit for state approval a new proposal that provides individual policyholders with coverage that meets Affordable Care Act requirements but doesn’t have a narrow network.
The Anthem proposal would have forced thousands of individual policyholders into a network composed almost entirely of MaineHealth providers and their affiliates. Under the plan, patients who bought individual policies after March 2010 could no longer use six Maine hospitals, including Central Maine Medical Center in Lewiston, Rumford Hospital, Bridgton Hospital and Parkview Adventist Medical Center in Brunswick, except for emergency care. They also would be prohibited from seeing doctors affiliated with those hospitals.
In July, the state approved a similar Anthem narrow network plan for individuals and small groups, but only for those buying insurance from the ACA marketplace, or exchange.
On Friday, the state denied Anthem’s request to move individual policyholders into plans with narrow networks. Those policyholders already have individual insurance with Anthem and would not be buying through the marketplace.
All of the doctors and hospitals that would have been excluded from the narrow network are based in southern and central Maine. About 7,000 policyholders live in those areas and would have been required to use the narrow network or find another insurer.
Anthem has estimated that, within the past year, about 489 of those people used a primary care physician who would have been excluded under the narrow network.
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