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Hundreds of Maine, NH health care providers missing thousands in payments from Anthem

With patient care potentially compromised, Maine's Board of Insurance is examining Anthem's provider-related issues.

PORTLAND, Maine — Therapists, optometrists, chiropractors — even doctors in some of Maine’s largest hospital systems are not being paid by one of the country’s largest health insurance companies.

Anthem told providers in an October memo that it was experiencing delays in the switch from one provider management system to another, and that a hiring shortage was exacerbating the problem.

“Anthem Blue Cross and Blue Shield in Maine is experiencing delays in the processing of provider applications and provider maintenance forms, creating delays in our ability to process provider claims,” the company said. “We sincerely apologize for these delays. We strive to process and pay claims as quickly and efficiently as possible and in accordance with the contractual agreements we have with our provider partners.”

Hundreds of providers say they properly filed claims for reimbursement of thousands of dollars, but the company says the new system does not recognize the providers’ billing identification numbers

Nevertheless, providers say they are missing tens of thousands of dollars in payments.

"No salary for several months," Rosemary McCullough, finance director of the Maine Psychologists Association, said.

"For the first couple of months, I thought I was the only one affected," she said. "In talking to other people, we realized, in fact, there's up to hundreds of people being affected by this. It's not a problem on the end of the provider."

Working for Change in Maine Mental Health Services, an online group of mental health providers, conducted a survey of roughly 70 therapists, licensed clinical social workers, and licensed clinical professional counselors. The survey found the payment problems have prompted many providers to leave or seriously consider leaving, the Anthem network, "thus limiting Anthem policy-holders' access to services," the group said.

The survey found:

  • 14% of those surveyed have already left the network or are in the process.
  • 58% said they are considering leaving the network if things don’t improve.
  • 28% said they’re not leaving the network, but most of those said it’s a difficult decision between self-preservation and discharging clients or not serving clients with Anthem when they want to give equal access to everyone.

Anthem is one of the largest insurance providers in Maine. Tens of thousands of state employees have Anthem for their health insurance, including school teachers, all three branches of state government, Maine Turnpike Authority employees, and the State Police.

With providers considering not taking Anthem, those patients could be forced to pay more: either in out-of-network costs, or out of pocket.

MaineHealth and Northern Light Health both confirmed that their providers are experiencing delays in payments. 

"We are hopeful that Anthem will respond to the urgency of this situation in the very near future and provide financial relief to all who have yet to be reimbursed for their services," said MaineHealth spokesperson John Porter.

"[W]e fully expect to be paid when Anthem has this issue fixed. Anthem is aware of this and is actively working to fix it," a spokesman for Northern Light Health said.

The New Hampshire Insurance Department's director of communications confirmed that health care providers in that state were experiencing the same problem, but would not specify how many providers are affected.

"The NHID is working individually with providers large and small to remedy this situation, and the number of providers affected is elastic," he told NEWS CENTER Maine.

A coalition of nearly 200 Maine psychologists, clinical social workers, and therapists who have contracts with Anthem sent a letter to Maine’s Bureau of Insurance to explain the problem.

“BCBS has become near impossible to work with and it’s affecting our ability to serve clients," the providers wrote. "Many clinicians are leaving insurance panels leaving clients unable to find in-network providers, and clients are negatively impacted by these issues."

Providers pleaded with the Maine Bureau of Insurance to get involved. Initially, the bureau’s staff told providers it would not get involved in contractual disputes between a provider and the insurance company.

In late October, bureau staff told NEWS CENTER Maine, “Since September, the Bureau has had been contacted by 15 providers” regarding the Anthem processing problems.

Now, the bureau is aware that the problem is more widespread across the state.

“We are aware of the issues and have been in regular contact with Anthem regarding their efforts to resolve them. We are also in the process of beginning an examination of Anthem which will include an examination of provider-related issues,” a BOI spokesperson wrote in an e-mail.

The Bureau’s superintendent, Eric Cioppa, told NEWS CENTER Maine that they have been in touch with Anthem weekly.

"Anthem is responsible to have enough providers available to meet the consumers' needs," said Cioppa. "To the effect it would affect that, we do have concerns."

While the bureau does not intervene in contract disputes between providers and carriers, Cioppa said, "Where we do get concerned is if it's a systemic issue and it affects network adequacy."

He said the board is specifically concerned that Anthem clients could have to pay in cash or seek treatment elsewhere.

The Bureau of Insurance is performing a “market conduct exam” to try to figure out why providers are not getting paid. The exam could result in Anthem being forced to pay the providers what they are owed, plus interest: 1.5% per month, or 18% per year.

Anthem said it has prioritized processing Maine provider maintenance forms, credentialing applications, and associated claims. The company also said it added staff to focus on applications and processing forms and expects the changes to “allow the providers’ claims to be processed in a timely and accurate manner.”

“We apologize for any delays this may have caused, and we ask any provider partner experiencing such challenges to contact their Anthem care provider experience representatives so we may work directly with you to resolve any issues. We are dedicated to those we serve and partner with and are focused on solving these recent challenges," wrote Stephanie DuBois, Anthem's director of communications.

DuBois said in an e-mail, “Over the last 12 months we have processed 92% of claims within 14 days and 97% of claims within 30 days.”

McCullough, of the Maine Psychologists Association, said she is considering her future contracts with Anthem, which could affect which clients she can see. She said Anthem covers 90% of the clients of one of the providers in her practice.

"We'll see what happens from here on out," she said Thursday. "This cannot continue. This has to be fixed."

Anthem declined to make someone available for an on-camera or Zoom interview but did respond to follow-up questions from NEWS CENTER Maine by e-mail.

DuBois would not say if any other states besides Maine or New Hampshire are experiencing this issue. She said Anthem emailed the Oct. 13 message to Maine providers who contract with them and provide an email address, as well as any providers who choose to subscribe to Anthem's emails. The company also posted it on the provider section of anthem.com.

"We have committed additional resources to assist our local Maine Provider Solutions team and hired new staff to better meet the needs of our provider partners, and we are already seeing decreased wait times. We take this very seriously, as we are dedicated to those we serve and partner with, and are focused on solving these recent challenges," DuBois said in response to providers' frustrations about not being able to complete the process of getting paid.