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Jay Reynolds, MD, is a senior vice president at Northern Light Health, president of AR Gould Hospital, and president of the Northern Light Medical Group.
As an Aroostook County native, I’ve spent my career serving the people of northern Maine, the last 30 plus years of which have been spent at Northern Light AR Gould Hospital. I have seen how access to local care affects the health of the population, my friends and neighbors. Our community is reliant on having a resilient, local health care system where patients and families can receive the care they need when they need it.
But as health systems across Maine and the country face difficult economic challenges, including increased costs for supplies, pharmaceuticals and labor, in addition to low reimbursement and high denial rates from payers, local hospitals are struggling to keep their doors open and health care services strong.
What could this mean? For a health system, this could lead to financial instability, physician migration and shortages, hard decisions to consolidate or close facilities and lengthy, one-sided negotiations with insurance partners. For patients, this could lead to delays in their care, lack of access to familiar providers and higher out-of-pocket costs for health care services due to out-of-network status with insurance companies.
Health systems like Northern Light Health exist to take care of patients. It is our ethical responsibility and mission focus to protect and preserve the health of our communities by ensuring they have access to care. A step toward achieving this goal is ensuring we have fair and equitable contracts with our insurance providers, so our health system can remain financially viable to provide care, and patients can remain in-network and continue seeing the doctors they know and trust from their local hospital of choice.
I have seen firsthand that when a patient loses in-network status with their local health care system they often feel loss of voice and control over their own health. Patients should never feel like their care is out of their own control. Patients deserve to have autonomy over where, when and how they receive health care services.
At Northern Light Health, we believe that decisions about care and medical services should be made by patients and their health care providers, and not by insurance companies whose ultimate loyalty is to their shareholders. When an insurance provider refuses to make reasonable agreements with health care providers, patients suffer.
This is particularly important in rural environments, like the population Northern Light Health serves, as these townships and communities often face even greater challenges, like transportation barriers, technology gaps, older demographics and higher rates of chronic illnesses. Patients deserve better; they deserve to receive the care they need, where they want to receive it from.
Discussions on insurance agreements are a normal part of the business of health care, and recently, Northern Light Health has achieved fair and equitable contracts with well-known insurance providers. However, we are not having the same success with Anthem. For several months, we have been working with Anthem to reach agreements on contracts for our services, but unfortunately, we don’t believe Anthem is being reasonable — and we are at risk for going out of network if we cannot reach an agreement by Sept. 30.
Specifically, if we do not reach a new agreement with Anthem by Sept. 30, for patients that have an Anthem commercial plan (excluding Medicare Advantage), Northern Light Health physicians, along with ancillary service providers (such as your primary care provider and specialists) will be out of network starting Oct. 1. Only hospital-based services will be paid at in-network rates through Dec. 31 (these include inpatient care and emergency department services as well as services from outpatient hospital departments, like Cancer Care, etc.).
This means patients will be billed for in-network cost sharing for physician services performed in conjunction with hospital-based services (e.g., surgeon services) even though our physicians will be out of network. For patients that have Medicare Advantage plans, our physicians, hospitals, and ancillary service providers will be out of network starting Jan. 1, 2026, if we do not reach a new agreement with Anthem by Sept. 30.
I will continue to advocate for my friends and neighbors, and I truly believe that it begins with protecting and preserving patients’ in-network access to care, particularly for those who call Northern Light Health their health care home.
