Negotiations between Maine’s largest health insurance provider and one of the state’s largest health care systems are not going well with each side once again blaming the other.
The contract between Anthem Blue Cross-Blue Shield and Northern Light Health runs out in a week.
The two sides have been publicly feuding over the contract for months.
Anthem claims Northern Light is negotiating in bad faith. Anthem released the following statement:
“For the second time in two months, Northern Light Health has walked away from negotiations with Anthem, including abandoning the mediation process we both agreed to. While we have more than doubled our initial offer, now up to a 5% increase for Commercial business, Northern Light has reduced its demand only slightly, insisting that Mainers and employers increase payments by nearly $200 million over the next three years.
Northern Light Health is also asking Anthem to make a series of changes to our contract with them – such as preventing Anthem from continuing to conduct industry-standard audits of claims submitted to us. We use these audits, in part, to protect our customers from paying more than they should for their care. We cannot agree to this and other similar demands.
We are disappointed but remain open to further discussions and compromise. However, because Northern Light Health has decided not to continue with mediation, we are now continuing to help our members navigate care options. Northern Light Health intends for its non-hospital facilities and healthcare professionals to leave our Commercial network starting October 1, and our Medicare network starting January 1.”
Northern Light says they were in mediation talks with Anthem when they said the insurance company stopped negotiating.
“Northern Light Health is disappointed to hear that Anthem publicly disseminated egregious misrepresentations of our mediation discussions. We have made no indication that we are walking away from negotiations, and their statements are not constructive to the mediation process. Anthem refuses to address our requests for contract language that protects Northern Light Health and the patients we serve. We remain available for the scheduled mediations if Anthem changes its mind and wishes to provide language to address Northern Light Health’s concerns,” Suzanne Spruce, the senior vice president and chief marketing and communications officer for Northern Light Health said.
In August, Northern Light Health Chief Financial Officer James Rohrbaugh said Anthem is increasing premiums on customers, while at the same time barely increasing the reimbursements paid to the hospitals.
Anthem Maine President Denise McDonough claimed that wasn’t true. She said the current contract included reimbursement increases that were at or above inflation. McDonough claimed Northern Light failed to meet an expected level of quality care.
Rohrbaugh said Anthem frequently denies payment for medically necessary care.
Anthem said Northern Light is looking to increase costs to patients by 30 percent over three years.
If a deal can’t be reached, Northern Light says its facilities will be considered “out of network” for anyone with Anthem’s insurance, and that means higher out-of-pocket costs for patients.