Anthem Blue Cross and Blue Shield expects a new, narrow-network insurance plan under an in-progress partnership between the health insurer and Portland, Maine-based MaineHealth will cost enrollees about 12 percent less than a broader plan would, according to a Portland Press Herald report.
Anthem and MaineHealth — the state's largest health system — intend to form an insurance network including 32 of the state's 38 hospitals to offer coverage through the new exchange that will open this fall under the Patient Protection and Affordable Care Act. The Maine Bureau of Insurance approved the proposed network in July. About 9,000 people would be transferred to the new plan under the pending collaboration, according to the report.
Anthem answered questions about its plans to transfer consumers to the new plan during a recent hearing held by the state insurance bureau, according to the report. Less than 10 percent of the insurer's individual subscribers use specialists and primary care physicians who aren't included in the new network, Anthem spokesman Chris Dugan said at the hearing, according to the report.
Officials from MaineHealth and Lewiston, Maine-based St. Mary's Regional Medical Center said at the hearing they have agreed to reduced reimbursement rates from Anthem in exchange for the insurer sending more patients to their hospitals through the narrow network, according to the report.
Last month, hundreds of state residents at a public hearing criticized Anthem's plan to shift enrollees to the new plan. Lewiston-based Central Maine Medical Center has said the plan puts insurance consumers in the central and western part of the state at a disadvantage, since they will have to travel farther to reach physicians.
The agreement between MaineHealth and Anthem will limit access to care for tens of thousands of state residents, Central Maine Healthcare Vice President of Public Affairs Chuck Gill said earlier this year. Mr. Gill called the arrangement a "backroom deal" that would exclude other health systems.
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