Healthcare costs are a real concern for families and businesses in Maine. Premiums and out-of-pocket costs continue to rise. Employers are trying to keep their costs in check and lawmakers are looking for long-term solutions. However, while there is no single fix, there are practical steps we can take.
At Anthem Blue Cross and Blue Shield in Maine, we believe focusing on costs starts with getting the basics right. That means paying claims quickly and accurately, reducing unnecessary paperwork, and making sure care is guided by clear medical standards.
Paying Claims Quickly
A claims system that works well helps everyone. Anthem processes more than half a billion medical claims annually. More than 95 percent are approved within 15 days.
For providers, this means reliable and timely reimbursement, allowing practices and hospitals to focus on patient care rather than billing follow-up. Prompt payment supports strong provider networks and reduces friction that can strain relationships across the system.
For employers, timely claims processing translates to fewer billing disruptions for employees and fewer escalations to HR departments. For legislators focused on system performance, it demonstrates that administrative efficiency at scale can reduce waste and improve the overall healthcare experience in Maine.
Reducing Preventable Denials
Claims denials can be frustrating. It is important, however, to ground the conversation in data. Denials are uncommon and are typically preventable. The most common causes here in Maine, in order, are:
1. Duplicate claims filed for the same service;
2. Eligibility issues (e.g., claims submitted to us for non-Anthem members); and
3. Billing/coding errors in the claim submission.
We recognize that even preventable denials create burden. That is why Anthem continues to invest in electronic claims tools, clearer benefit information, and improved data sharing to reduce avoidable errors. By streamlining submission processes and improving transparency around coverage requirements, we aim to minimize administrative friction and ensure providers are paid promptly for the care they deliver.
For employers and policymakers, reducing avoidable denials is not just about convenience, it is about eliminating unnecessary administrative costs that ultimately drive premiums higher.
Using Prior Authorization Responsibly and Sparingly
Prior authorization is often debated. The reality is that we use it in a limited and targeted way. Only approximately 3 percent of non-emergency care requires prior authorization. (Emergency care is never subject to prior authorization.) The vast majority of care proceeds without additional review, and most prior authorization requests are ultimately approved.
We are committed to ensuring our members receive safe, high-quality, evidence-based care. Prior authorization helps confirm that services meet established clinical guidelines while supporting appropriate, cost-effective treatment.
At the same time, we recognize the need to continuously improve. Since January 2024, Anthem has removed prior authorization requirements for more than 400 services. We are committed to ongoing evaluation of where requirements can be streamlined or eliminated without compromising quality or safety.
For providers, this means a continued focus on simplification. For employers, it means responsible oversight that helps manage long-term cost trends. For legislators, it demonstrates that utilization management can evolve in response to stakeholder feedback.
A Shared Responsibility for Maine’s Future
No one group can solve rising healthcare costs alone. Providers are facing higher operating costs. Employers also face rising costs, and healthcare is typically their second highest expense, after payroll. Lawmakers must balance complex priorities. Health plans must ensure that premium dollars are spent wisely, as healthcare costs drive premiums.
The path forward requires accountability from all involved. Paying claims promptly, reducing avoidable administrative barriers, applying clinical review thoughtfully and sparingly, and continuously modernizing systems to reduce complexity are daily focus areas for us at Anthem.
We remain committed to collaborating with providers, employer-customers, and policymakers in Maine to build a system that delivers value — one that supports high-quality care while also containing costs for the people and businesses who depend on it.
