Northern Light Health and Anthem have just hours to settle a monthslong contract dispute.
Depending on the outcome of any eleventh-hour talks, tens of thousands of Mainers, including state government workers, could either go on with health care as usual or be faced with the uncertainty of their current doctors and services moving outside the network of the state’s largest private health insurer.
Northern Light’s contract with Anthem expires at the end of the day Tuesday.
Northern Light patients and other providers in the state have raised concerns that the separation would most immediately complicate care for people needing specialist care, especially in rural parts of the state where there aren’t many options besides Northern Light.
Victoria Glover, a family medicine provider at Full Circle Health Care in Presque Isle, told the Bangor Daily News earlier this month that she sometimes refers patients to Northern Light’s Eastern Maine Medical Center in Bangor for services like cardiology, but has started sending people to MaineHealth in Portland for those services if they can make the four-hour trip.
“The immediate worst impact is going to be those people that need the services that only Northern Light provides,” she said. “North of Augusta, that’s going to be stuff like radiation oncology and cardiac procedures.”
If no agreement is reached Tuesday, patients with private or employer-based Anthem insurance will see their primary care providers and specialists move out of network. Hospital care will remain in network through the end of the year.
For patients with Anthem Medicare Advantage plans, both primary care and hospital services will remain covered through the end of the year.
Some people getting longer-term care for serious illnesses or pregnancy from Northern Light providers may be able to continue getting those services at in-network costs for a “limited period” through a process called “continuity of care,” which they must apply for through Anthem.
The dispute between Brewer-based Northern Light Health and the state’s largest private health insurer went public months ago as they came to loggerheads over a new contract.
James Rohrbaugh, executive vice president and chief financial officer for Northern Light, 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 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.
Then, last week, Anthem went public with complaints about Northern Light walking away from mediation despite offering a 5% increase for commercial business. Anthem also claimed that Northern Light proposed contract changes that the insurer says would prevent audits that protect customers from overpaying for care.
A Northern Light spokesperson called claims that the system walked away from mediation “false.”
On Friday, Northern Light President and CEO Timothy Dentry chastised Anthem in an open letter, saying the insurer’s statements undermined both mediation and public trust in their respective organizations.
Dentry then aired his own complaint against Anthem, writing in his letter that the insurer has created “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 then the week prior, Dentry claimed, 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.
In his letter, Dentry noted that Northern Light 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.
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.
Meanwhile, Dentry is stepping down as the leader of Northern Light, a post he held for five years. He will be replaced by Guy Hudson in October.
Hudson’s arrival comes during a tumultuous period for Northern Light. Before the dispute with Anthem became public, the health system was grappling with financial turmoil, a period that has seen it shed services, announce the closure of its Waterville hospital and its Bangor walk-in clinic, and the departure of several high-level leaders.
More cuts and service changes are coming to Northern Light in the coming months.
The financial turmoil gripping Northern Light may be compounded by federal Medicaid cuts and a state law expanding charity care.
BDN writer Annie Rupertus contributed to this report.
