Northern Light Health is firing back at Anthem, accusing the state’s largest private insurer of undermining the mediation process.
That comes as Brewer-based Northern Light and Anthem face a Tuesday deadline to reach a contract to keep the health system in the insurer’s network. If no agreement is reached, the system’s hospitals, primary care and other services will move outside Anthem’s network Wednesday.
Failure to reach an agreement will affect 30,000 Mainers, including state government workers.
In a Friday letter to Anthem Blue Cross and Blue Shield’s president, Northern Light Health President and CEO Timothy Dentry expressed disappointment over the insurer’s claims this week that the health system had walked away from mediation talks.
“At no point have we indicated that we are walking away from the mediation. In fact, we remain fully engaged, committed, and ready to continue working toward a resolution,” he wrote in the letter to Denise McDonough, Anthem’s president in Maine.
Earlier this week, Anthem went public with complaints about Northern Light Health walking away from mediation despite offering a 5% increase for commercial business. Anthem also claimed that Northern Light was proposing contract changes that the insurer says would prevent audits that protect customers from overpaying for care.
A Northern Light Health spokesperson called claims that the system was walking away from mediation “false.”
On Friday, Dentry said that Anthem’s public statements this week violate mediation principles, undermining mediation itself and public trust in both organizations.
“Our goal throughout this process has not just been about reimbursement. These negotiations are about how we work together to deliver high-quality care,” Dentry said.
“Unfortunately, your organization has made that increasingly difficult,” he went on to say.
A statement from Anthem wasn’t immediately available Friday morning.
The public sparring between Northern Light and Anthem isn’t new. They have traded blows throughout the summer as they remain at loggerheads in contract talks.
James Rohrbaugh, executive vice president and chief financial officer for Northern Light Health, said in June that Anthem’s reimbursement rates have increased at a rate of less than 1.5% despite the annual inflation rate for health services averaging 7.5%. Reimbursement for services is necessary to keep hospitals, practices and services open and staffed, Northern Light has said.
Additionally, Northern Light Health has pointed to Anthem’s increase in payment denials for patient care and the 10% increase in its profit margin in Maine.
Northern Light Health broke off contract negotiations with Anthem in mid-August. In severing negotiations, Northern Light said it sent Anthem a counteroffer on July 30, but the insurer declined to submit a response. The system came back later that month as both sides entered mediation.
Dentry aired his own complaint against Anthem on Friday. In his letter, Dentry said that Anthem was creating “confusion,” “delays” and “unnecessary stress” for patients battling cancer and other serious conditions as they seek to continue their care. Patients had been directed to fill out an online “continuity of care” form on Anthem’s website to ensure coverage for treatment through the end of the year. But last week, Dentry claims, Anthem began instructing patients to instead call to complete that process.
Dentry called that an “unacceptable burden” on patients and their families as they seek “life-sustaining” care.
“Let us be clear: medical decisions must remain in the hands of physicians, not dictated by opaque, profit-driven administrative systems. Our physicians did not go into medicine to battle with insurance companies over forms, Anthem operational protocols, or misinformation campaigns. And yet, that is increasingly the reality they face,” he wrote.
In his letter, Dentry noted that Northern Light Health has completed negotiations with Community Health Options and Harvard Pilgrim this year without similar fireworks and public sparring, saying that the system has encountered “resistance” and “rigidity” from Anthem’s negotiating team throughout the talks.
“Our goal remains simple: to serve our patients and our community without disruption or delay. But right now, Anthem is standing in the way of that mission,” wrote Dentry, who is stepping down as Northern Light Health’s leader. He will be succeeded next month by Guy Hudson.
In 2022, a contract dispute between MaineHealth and Anthem played out in public, with the health system accusing the insurer of owing millions in back payments and holding up and disputing millions more in payments, while Anthem accused MaineHealth of millions in overcharges.
Before the contract expired, both sides reached a deal, preventing MaineHealth from withdrawing from Anthem’s network.
