June 28, 2013

Anthem defends network plan to state regulators

Proposal that excludes some hospitals has come under fire from doctors and patients.

By Jessica Hall jhall@pressherald.com
Staff Writer

GARDINERAnthem Blue Cross and Blue Shield said Friday that its proposed health insurance network with MaineHealth would provide adequate numbers of hospitals and health care providers for Mainers who seek coverage through the insurance exchange to be created by the Affordable Care Act.

In a hearing held by the state's Bureau of Insurance, Anthem said its proposed network, including 32 of Maine's 38 hospitals, would allow every subscriber to reach a primary care physician within 30 minutes and a specialist within an hour's driving time.

The company said it does not know how many Mainers would join the network.

The proposed network has come under fire, with some doctors upset that they would be excluded and some patients fearful that they would no longer be able to go to the doctors and hospitals they now use.

The proposal appears to run counter to President Obama's pledge that people will be able to keep their doctors and health plans under the Affordable Care Act.

Anthem customers who bought their plans before March 23, 2010, would be allowed to keep their coverage, which includes access to all hospitals in the state, Anthem said.

Only customers who have bought their plans since that time, or new subscribers who buy coverage on Maine's health insurance exchange, would have to use the more narrow network of 32 hospitals.

Anthem said it has about 19,000 individual subscribers in Maine, and about half of them would be allowed to stay in the broader network.

Anthem defended its decision to develop the plan with MaineHealth, the state's largest network of hospitals and health providers, and to exclude the three hospitals owned by Central Maine Healthcare of Lewiston, along with Parkview Adventist in Brunswick, York Hospital in York and Mercy Hospital in Portland.

The proposed Anthem-MaineHealth network is one of two plans that would be sold through the insurance exchange.

The other plan is proposed by Maine Community Health Options, a nonprofit, co-op insurance program. Both plans need reviews by the Bureau of Insurance by July 31 and approval from federal regulators.

"Our eyes were wide open that we'd be competing in the exchange and there would be alternatives available," said Colin McHugh, regional vice president of provider engagement and contracting for Anthem.

"Consumers can buy this product or another one. We think customers have a right to that choice."

"There will be consumers who say they are comfortable traveling a little farther for their (primary care physician)," McHugh said.

Friday's hearing centered on whether the Anthem-MaineHealth network would be adequate.

Information on pricing and structure of the plans has not yet been released and was not part of Friday's hearing.

The health insurance exchange will target the roughly 260,000 Mainers who have individual or small-group insurance plans and those who now are uninsured. Enrollment is expected to begin in October. The plans would take effect Jan. 1.

By controlling which hospitals are involved in the network, Anthem and MaineHealth can contain costs, the companies say. The hospitals that would be in the network agreed to accept reduced payments from Anthem in exchange for having more customers directed to their facilities.

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