A Catholic health care system with hospitals in Maine and a major insurance company have put more than 14,000 patients and their services at risk until they resolve their differences a month before their contract expires.
Covenant healthThe Family and Pennsylvania Division of Catholic Health Care Organizations in New England and insurers Anthem Blue Cross and Blue Shield have been negotiating since October 2022. The insurer and St. Joseph Healthcare Bangor or St. Mary Health System in Lewiston, according to a spokeswoman for both companies.
The contract expires July 4, which is the last day Covenant Health facilities and medical professionals will be in the YouM network, said Stephanie DuBois, a spokeswoman for Anthem Blue Cross and Blue Shield of Maine.
The insurer has begun directing members to other health care providers, which often offer a wider range of services at a lower cost. Another spokeswoman said this could include Northern Lights Eastern Maine Medical Center in Bangor and Central Maine Medical Center in Lewiston, among other locations.
Anthem and Covenant Health have argued that their focus is on securing quality and affordable health care for patients and pointing to each other as obstacles to negotiations. This puts more than 14,000 Maine patients in a difficult position, possibly having to change health insurance or medical care providers.
In the year As of December 31, 2022, 295,704 people in Maine were enrolled in the six largest health insurance companies. Figures Insurers must file with the Insurance Bureau every year. Of the listed insurers, Anthem had 156,891 enrollees, or 53 percent.
A St. Joseph’s Healthcare patient pointed out how health care and insurance can be confusing for many to travel, and this confusion makes the process even more frustrating. Some patients were concerned about what would happen to their relationships with doctors and referral services and wondered how they would prepare if Anthem and Covenant Health couldn’t agree.
“I believe this will be resolved,” said Jan Jones, a Glenburn resident and patient at St. Joseph’s Healthcare. But what does this do to the trust in your hospital and the trust in your insurance company to keep it? This shakes people up.
Earlier this month, Jones said she received a letter dated May 4 from the Blue Cross and Blue Shield federal worker program, which she appreciated. The insurer will continue to pay for covered benefits until 90 days from the date of the letter, or August 2, according to the letter. Information for members in various plans is also listed.
Jones and her husband, Chris, are enrolled in Medicare and use Anthem as supplemental insurance.
A Covenant Health customer service representative with whom Jones spoke on May 15 was unaware of the notice sent to patients and was unable to answer her questions, Jones said. The agent seemed confused, indicating to Jones that she would not be able to do that until the open enrollment period in December.
“They’ve got all these people hanging on,” she said, referring to potential gaps in coverage.
After July 4, for a limited time, members can continue to receive care with their provider, even if that person leaves the network. The insurer. That includes patients who are pregnant, critically ill, scheduled for surgery not recommended by their current physician, hospitalized or inpatient, and undergoing treatment for complex conditions.
Anthem has proposed “reasonable increases over the next several years” that will address the rising cost of health care delivery, and “Covenant Health is seeking double-digit increases that are more than three times inflation,” said DuBois, a spokeswoman for Anthem. Although she did not provide figures in the statement.
Maine consumers and businesses can’t afford the increase, she said.
“Covenant Health is focused on protecting patients’ relationships with their physicians,” spokeswoman Karen Sullivan said in a statement. She said Pledge wants to structure an agreement that provides fair payment to providers and hospitals, as well as providing services at affordable prices.
On the websites of Bangor and Lewiston hospitals, Promise Health wrote about it. Latest update Anthem was disappointed with the terms and rates it offered, which was deeply rooted in the insurer’s recent financial performance.
Elevance Health, Elevance’s parent company; reported In the first quarter of this year, it generated nearly $2 billion in revenue and added more than 1 million new members.
“As with all potential supplier disruptions, [Maine Education Association] “The Benefits Trust understands that members are concerned about continuity of care,” said the organization that represents public school workers. on the website At the beginning of May. “We recognize that supplier contract disputes create uncertainty and uncertainty for our members.”
The Maine Municipal Employees Health Trust, which serves municipal and county governments, has notified its members; Expressing concern About lack of access to providers and hospitals.
If Jones and Covenant Health don’t resolve their differences, she will have to wait until October to be seen, making an appointment with an internist at Northlight Eastern Maine Medical Center.
Few Bangor providers accepting new patients turned up in her online search, Jones said, and she specifically looked for an internist rather than a family medicine practice.
In separate statements, Anthem and Covenant Health emphasized their commitment to patients and their responsibility to keep health care affordable.
Jones sees the restoration of services that patients pay for without changes to coverage as a positive outcome.
“This big ball of wax could be useful to a lot of people,” she said, especially disadvantaged Mainers. “Hard choices are going to be made. [For some] Not going to the doctor, not getting a mammogram, not being able to get bloodwork done can add to the inability to perform.
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