Portland Press Herald

Anthem Blue Cross and Blue Shield won a key approval Thursday from the state Bureau of Insurance for its plan to partner with MaineHealth on the new health insurance exchange.

The decision by the Bureau of Insurance to approve the Anthem-MaineHealth network is a blow to Central Maine HealthCare, which is not included in the plan. Central Maine HealthCare had argued that Anthem’s proposed network was a “back-room deal” that failed to include providers in central and western Maine and could require patients to change doctors to get care.

The proposed Anthem-MaineHealth pact includes 32 of the 38 hospitals in the state and excludes 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.

Despite the objections from excluded hospitals, the Bureau of Insurance on Thursday approved the proposed network with some conditions. It instructed Anthem to contract with additional specialists in certain areas.


“Overall, I find Anthem’s network — with the modifications and conditions imposed herein — to be capable of providing ‘reasonable access to health services,'” Eric Cioppa, the superintendent of insurance, said in the order.

Anthem, the largest health insurer in the state, and MaineHealth, the state’s largest network of hospitals and care providers, want to offer the insurance network on the new health exchange being created under the Affordable Care Act. The proposal, however, appears to run counter to President Barack Obama’s pledge that people will be able to keep their doctors and their health plans, critics said.

The bureau did not address the issue of product pricing. That remains subject to approval later this month.

The bureau called for a hearing on Sept. 9 to address the issue of whether Anthem could move its current customer base into the proposed network.

“Simply because I am permitting Anthem to offer these narrow-network plans for sale in Maine does not necessarily mean I will also permit Anthem to move its current customer base into these plans,” Cioppa said.

Central Maine HealthCare had slammed the proposed Anthem-MaineHealth network as discriminating against insurance subscribers in central and western parts of the state, who would have to travel farther to reach doctors in the plan. In hearings last month, Anthem said the network was designed so that every subscriber could reach a primary care physician within 30 minutes and a specialist within an hour’s driving time.


“If the access provided is reasonable, it is irrelevant that the network could be bigger or better,” Cioppa said in the order.

Still, critics have said the plan counters Obama’s vision for the Affordable Care Act.

In an address to the American Medical Association in July 2009, Obama said: “No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away, no matter what.”

Anthem previously said that 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.

Chuck Gill, a spokesman for Central Maine Healthcare, said Thursday that Central Maine officials are disappointed in most of the Maine Bureau of Insurance’s decision. Central Maine will decide in the next few weeks whether to appeal the decision by the insurance bureau, Gill said.

Under the Affordable Care Act, people can buy health insurance starting Oct. 1 on the exchanges for coverage that begins in January. Those earning between 100 percent and 400 percent of the federal poverty line will be eligible for subsidies on the exchanges. 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.


Only the Anthem and Maine Community Health Options, a nonprofit co-op insurance plan, have applied to compete on the exchange in Maine. The plans offered by Maine Community Health Options would cover the entire state.

Central Maine HealthCare on Thursday maintained that the Anthem network would fail to provide reasonable access to care for all subscribers.

“We don’t believe driving an hour to receive primary care is reasonable service,” Gill said, describing potential situations where Anthem HMO customers in western Maine would have to drive to Portland to see their doctor. “We don’t believe that’s reasonable access to care.”

Gill said while it’s true that many individuals living in western Maine who buy insurance on the new health care exchanges would instead choose the other provider operating on the exchange — Maine Community Health Options — some may not have that choice.

“What if I live in Rumford and my employer in Lewiston chooses the Anthem plan?” Gill asked.

Anthem and MaineHealth previously said that the proposed network, which excludes certain providers, would help cut costs. MaineHealth, for example, agreed to take lower reimbursement rates in exchange for more customers being directed to its network of hospitals and care givers.


“Anthem Blue Cross and Blue Shield in Maine is pleased that our proposed network has been approved by the Maine Bureau of Insurance subject to conditions, which we are taking the necessary steps to meet,” Anthem spokesman Chris Dugan said in a statement.

The new network will be available for customers who choose to buy Anthem’s individual or small group plans for 2014.

“Simply passing along increasing costs in the form of higher premiums is not acceptable. That’s why Anthem collaborated with MaineHealth and selected providers across the state to develop a comprehensive provider network that could be paired with the new products to slow the rate of premium increases,” Dugan said.

The proposed plans from Anthem-MaineHealth and Maine Community Health Options are subject to federal approval.

Portland Press Herald staff writer Joe Lawlor contributed to this story.

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