Central Maine Healthcare files suit against state, says federally subsidized insurance would exclude some hospitals

Posted June 18, 2013, at 5:53 a.m.
Last modified June 18, 2013, at 8:47 a.m.

LEWISTON, Maine — Anthem Blue Cross and Blue Shield wants to form a new insurance plan with MaineHealth. And it wants the state to keep the details of that plan secret as it seeks approval from the Maine Bureau of Insurance.

The state has said OK.

Central Maine Healthcare has said no fair.

Now it’s asking a judge to make Anthem’s application public and to give the public more time to comment on it before the bureau decides whether to approve the new insurance plan.

“We believe the public has a right to know what’s going on,” said Chuck Gill, spokesman for CMHC.

CMHC, on behalf of Central Maine Medical Center in Lewiston, area doctors and patients, filed suit in Kennebec County Superior Court late last week against Eric Cioppa, superintendent of the Bureau of Insurance, and the Maine Department of Professional and Financial Regulation. It asks the court to open the Anthem documents made confidential by the bureau, give the public more time to comment on the proposal and postpone the bureau’s June 28 hearing on the insurance plan.

Because that hearing is less than two weeks away, CMHC also asked the court to expedite its ruling. A judge is expected to consider that motion in the coming days.

Late Monday, the Bureau of Insurance said it would release some of the information CHMC is seeking: which doctors and hospitals the plan will and won’t allow patients to use. In his order to release the information, the bureau’s superintendent said, in part, the provider network list must be filed publicly with the bureau by July 1 anyway and that making the information available two weeks early is highly unlikely to allow a competitor to gain advantage.

That information is set to be released at 4 p.m. Tuesday. Anthem could ask a court to block its release. Gill said CMHC will wait to see the information before deciding whether it’s enough for the organization to drop its court action.

A representative for Anthem offered no comment on the information’s release.

At issue is a proposal by Anthem, the state’s largest health insurer, to partner with MaineHealth, the state’s largest health-care organization, to offer a new insurance plan for the upcoming Affordable Care Act health insurance exchange. Thousands of Mainers could be eligible to receive federal subsidies to pay for the insurance plan.

But CMHC said Anthem and MaineHealth want to strictly limit the doctors and hospitals the insurance plan will pay for. MaineHealth and its affiliates would be in. MaineHealth competitors, CMHC and its affiliates — including Rumford and Bridgton hospitals — would be out.

“In Rumford, all the doctors in that community work for Rumford Hospital, so people will literally have to leave town to find a new doctor. That’s unacceptable,” Gill said.

Anthem brought its proposal to the Bureau of Insurance in May. Central Maine Healthcare asked for the details of that proposal so it could protest the plan as an intervenor. But CMHC officials said the bureau told them Anthem had asked that its application and its contents remain secret because they included confidential and proprietary information, and the bureau agreed.

CMHC filed a Freedom of Access Act request in an effort to compel the bureau to release the information. CMHC said that request was largely denied.

Bureau spokesman Doug Dunbar said Monday that requests for confidentiality are not unusual and the bureau has a standard formal process to determine whether documents should be secret or public. He said that process has been ongoing in this situation and the bureau is still reviewing whether the other documents CMHC wants should be public or not.

According to CMHC, the bureau announced on June 6 that it would start accepting petitions from interested parties to intervene and show how they would be affected by the proposed insurance plan, but the details of the plan weren’t made public for people to be able to tell how they would be affected.

In addition, CMHC said, the bureau gave interested parties only until June 12, four business days, to file as intervenor, and some public notices about that deadline weren’t published until after June 12.

“The most important thing is for the public to become informed,” Gill said. “They’ll wake up some day and say, ‘Wait a minute, I can’t go to my own doctor? I thought I could.’ It’s important for the public be informed before the fact occurs, not after the fact.”

Dunbar said the bureau must complete its review of health insurance exchange plans by July 31 and report its recommendations to the U.S. Department of Health and Human Services. That department then decides whether a plan should be considered “qualified.”

Anthem spokesman Christopher Dugan declined to comment on the lawsuit, but said in an email that the insurance company is “working to develop an innovative collaboration aimed at reducing health care costs and slowing the rate of premium increases.”

Gill noted that an Onpoint Health Data analysis recently named Rumford and Bridgton hospitals among the lowest-cost hospitals in the state and CMMC the lowest cost of the state’s three tertiary-care hospitals, including MaineHealth’s affiliate, Maine Medical Center in Portland.

Anthem has previously had a good relationship with CMHC. In April, it named Central Maine Medical Center’s Orthopaedic Institute a “Blue Distinction Center” for knee and hip replacement surgery, lauding the hospital’s clinical expertise and quality of care.

“This recognition is a true testament to the care provided at CMMC,” said Jeffrey Holmstrom, Anthem’s medical director, in a written statement at the time. “We are always working in partnership with all Maine hospitals and physicians to help improve the quality of care delivered to our members. We’re pleased to share this designation with our members so that those whose benefits plans include coverage for these services have the information they need to make important health care decisions for themselves or their family members.”

Representatives for MaineHealth could not be reached for comment.

SEE COMMENTS →

ADVERTISEMENT | Grow your business
ADVERTISEMENT | Grow your business