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Anthem partners with Northern Light Health facilities as Tier 1 providers

The move allows Anthem members access to hospitals with lower-cost options and incentives.

SOUTH PORTLAND, Maine — Two Northern Light Health hospitals will soon offer potentially lower copays for many services after partnering with Anthem Blue Cross and Blue Shield to become Tier 1 providers.

Northern Light Inland Hospital in Waterville and Northern Light Mercy Hospital in Portland will become Tier 1 providers in Anthem’s Maine HMO Tiered Options Plans.

The move "ensures quality and affordability," according to a joint news release from Northern Light Health and Anthem. Anthem’s Maine HMO Tiered Options Plans are available to members in individual, small group, and large group health plans.

The release notes Anthem members have access to healthcare professionals and hospitals with lower-cost options and incentives under Anthem’s Maine HMO Tiered Options Plans. 

Anthem and Northern Light Health said in the release that by selecting a healthcare professional or hospital in Tier 1, members "could see significant savings in cost shares for healthcare services – such as lower copays for primary care physician and specialist office visits, lower coinsurance costs, and up to $3,000 in savings on deductibles, depending on the plan."

With the addition of Northern Light Inland Hospital and Northern Light Mercy Hospital on July 1, 2022, all 10 of Northern Light Health’s hospitals as well as its healthcare professionals will be included in the top tier for Anthem’s Maine HMO Tiered Options Plans.

The move comes as some Maine hospitals and medical practices are announcing they will stop accepting Anthem for in-network coverage. Some of the issues center around hospital systems not receiving payments. MaineHealth, the parent company that operates Maine Medical Center in Portland, said its system of hospitals at one point was owed roughly $70 million.

Other practices report contract disputes with Anthem about how much the practice should charge for certain services. In May, Coastal Women's Healthcare, the largest independent OB/GYN practice in the state, said it would drop the insurance carrier in August of 2022. President Dr. Barbara Slager said Anthem was paying CWH "half" of what other comparable practices were receiving. She said roughly 38 percent of CWH patients have Anthem. Slager added Anthem used that large percentage as leverage to offer low reimbursement rates, knowing that if CWH did not renew the contract, it could possibly go out of business.

When asked about the lack of payments, Suzanne Spruce, communications director for Northern Light Health said in an e-mail:

"We do continue to experience some delays with out of state and Medicare Advantage claims, and we are still meeting monthly with Anthem to review outstanding issues," Spruce wrote. Northern Light Health is delighted to be working with other Maine healthcare providers participating in this network."

According to Gov. Janet Mills ' office, Anthem is Maine's largest insurer, covering 300,000 people. State of Maine employees and tens of thousands of other public service employees have Anthem for their health insurance.

“Northern Light Health is pleased to accept Anthem’s invitation for our facilities in Portland and Waterville to join Tier 1 for their Maine HMO Tiered Options Plans,” said president and CEO, Timothy Dentry in the release. “The inclusion of Northern Light Mercy Hospital and Northern Light Inland Hospital will expand access to high quality, affordable healthcare, and we are delighted to be working with other Maine healthcare providers participating in this network. This will help ensure the best care possible for Maine residents.”

“We’re committed to providing access to quality, outcomes-driven healthcare, and our partnership with Northern Light Health will expand affordable care options available to Maine healthcare consumers in the southern part of the state,” said Denise McDonough, president of Anthem Blue Cross and Blue Shield in Maine in the release. “We know that Maine consumers want quality, access, and choice, and we’re excited to continue to work with Northern Light Health on our shared goal of protecting healthcare affordability for Mainers.”

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