MaineHealth, Anthem work out contentious, months-long contract dispute

FILE PHOTO Maine Medical Center, the state's largest hospital with 700 licensed beds in Portland, will continue to treat patients under Anthem in-network insurance rates.

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By William Hall

Maine’s largest health care system and largest health care insurer seem to have patched up their differences for now, saying Wednesday afternoon that a four-month contract dispute has been settled.

MaineHealth and Anthem Blue Cross and Blue Shield in Maine announced they had inked an agreement that will keep Maine Medical Center, the 700-bed Portland flagship hospital of MaineHealth, in Anthem’s network of care providers.

News releases from both MaineHealth and Anthem disclosed no terms or details. Other MaineHealth facilities and providers were not affected by the dispute and remain in Anthem’s network.

The deal averts what could have been costly chaos for the state’s health care industry, and means Mainers insured by Anthem can continue to receive in-network services at Maine Med over the next two years.

MaineHealth in April threatened to leave Anthem’s network because the insurer, MaineHealth said, hadn’t paid medical bills amounting to millions of dollars.

For its part, Anthem said MaineHealth had overbilled by millions of dollars.

Both parties publicized their claims extensively. Business and political leaders, including Gov. Janet Mills, weighed in. MaineHealth said it would pull Maine Med from the network in 2023, despite a contract that was in force through September 2024.

If MaineHealth had made good on its threat, the change could have forced higher out-of-pocket costs upon any Mainer with Anthem coverage, whether from an employer or through policies purchased from the insurer, including via the state-run health insurance exchange.

MaineHealth is the largest health care system in northern New England, with a network of nine hospitals, 1,700 providers and 22,000 employees serving 1.1 million residents of Maine and New Hampshire. Anthem covers roughly 300,000 Maine residents, or slightly more than half the state's health insurance market.

Threats like MaineHealth's are typical tactics in the bargaining between health care providers and insurers. But compared to recent face-offs nationally, this one was unusual because of its length and public visibility.

In the news releases, MaineHealth CEO Dr. Andy Mueller said, “Our agreement with Anthem provides both of us with the opportunity to reaffirm our relationship as we work to improve the health and well-being of our communities.”

Denise McDonough, president of Anthem Blue Cross and Blue Shield in Maine, said, “Continuing our partnership with MaineHealth is important to maintaining and improving access to health care at Maine Medical Center. We value the relationships we have with the providers in our network.”