After a monthslong dispute, Northern Light Health’s contract with Anthem insurance has expired after the parties failed to reach an agreement through mediation. While the organizations may still reach a deal past the deadline, that means many patients will be charged out-of-network costs starting today.
Here’s what you should know if you get health care from Northern Light and insurance coverage from Anthem.
Which types of care are now considered out-of-network?
For patients with private or employer-based Anthem insurance, primary care providers and specialists are now 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.
Emergency room services will always be covered at the in-network cost, according to Northern Light. A federal law passed in 2022 protects patients from surprise bills and out-of-network cost sharing for most emergency services.
Could Northern Light and Anthem still reach an agreement?
Yes, health systems and insurance companies sometimes continue negotiating past contract deadlines. Still, Northern Light care is out-of-network for now and will remain out-of-network until the two organizations reach a new contract, if that happens. It’s unclear if mediation will continue or how long it will take if it does.
In a dispute with a Missouri health system earlier this year, Anthem let a contract expire after the two parties failed to reach an agreement, leaving many patients without coverage for three months.
What are my options?
Patients with private or employer-based Anthem insurance will now be charged out-of-pocket for primary care providers and specialists at Northern Light. Some may consider switching insurance providers or finding new doctors.
Maine’s insurance marketplace offers an open enrollment period from Nov. 1 to Jan. 15. For coverage starting Jan. 1, the deadline to enroll is Dec. 15.
For Medicare Advantage patients, the open enrollment period runs from Oct. 15 to Dec. 7, according to Northern Light.
People who are insured through an employer, however, will likely need to find other solutions. Many major employers, including the state of Maine itself, provide Anthem insurance to employees.
Anthem customers can also search for alternative in-network care options on Anthem’s website.
What if I have a serious health condition?
Some people getting longer-term care 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,” if they are approved by Anthem, the insurer said.
Conditions that may qualify for this extension include pregnancy, serious illnesses like cancer, transplant candidates, terminal illness, certain major surgeries, and certain acute or chronic conditions, according to Northern Light.
Patients who may fall into one of those categories can apply for coverage to be extended by calling the number on the back of their insurance cards.
