State to hold public comment session on Anthem plan that puts strict limits on hospitals, doctors that policyholders can use

By Lindsay Tice, Sun Journal
Posted Aug. 25, 2013, at 3:19 p.m.

The Maine Bureau of Insurance will hold a public comment session Thursday on Anthem Blue Cross and Blue Shield’s proposal to move a number of its current individual policyholders into a narrow network plan that strictly limits which hospitals and doctors they can use.

In central Maine, Central Maine Medical Center in Lewiston, Bridgton Hospital, Rumford Hospital and Parkview Adventist Medical Center in Brunswick would be excluded from that network. St. Mary’s Regional Medical Center in Lewiston, Franklin Memorial Hospital in Farmington, Mid Coast Hospital in Brunswick and Stephens Memorial Hospital in Norway would be included.

The comment session will begin at 5 p.m. and will be held in Kirk Hall at Central Maine Community College in Auburn.

Following that session, at 6 p.m., the bureau will hold a public information session on the Affordable Care Act.

Anthem’s plan represents a partnership between the largest health insurance company in the state and MaineHealth, the largest health care organization in the state. All MaineHealth hospitals and affiliates are in the plan. Six Maine hospitals and their affiliates, all in some way competitors with MaineHealth or its affiliates, are out.

Anthem first proposed its narrow network for the upcoming Affordable Care Act health insurance marketplace, also known as an exchange. Individuals can receive a federal subsidy to help pay for their insurance if they buy from the marketplace and if they make up to 400 percent of the federal poverty level.

The state approved that plan last month. The plan must still win approval from the federal Centers for Medicare and Medicaid Services. However, the federal government is expected to accept the state’s judgment on Anthem’s network.

Anthem is now asking to move a number of its current individual policyholders to the same narrow network. Thursday’s public hearing will address that proposal.

Grandfathered plans — those purchased before March 2010 — could be exempt. About half of Anthem’s 17,500 individual policyholders are in a grandfathered plan.

The narrow network has proven controversial, with Lewiston Mayor Robert Macdonald and Central Maine Healthcare publicly opposing it.

“This anti-competitive plan is designed to make it more difficult for Anthem patients to seek local medical care and services, will force many to change physicians, and will negatively impact Central Maine Healthcare, one of our region’s largest employers,” Macdonald said in a statement released earlier this month. “This proposal is bad for patients, bad for CMMC and bad for the entire Lewiston-Auburn region.”

Macdonald said Friday that he will attend the hearing.

“I was elected mayor here to fight for these people and that’s what I’m going to do. I’m not going to sit by and just let this thing happen,” he said.

Central Maine Healthcare owns three of the hospitals not in the network and has a relationship with a fourth. It’s created ads and a website, www.keepcarelocal.com, to urge people to oppose Anthem’s plan. CMHC spokesman Chuck Gill said he receives calls and emails every day from Mainers concerned about the proposed network.

“People are concerned, not only for the issue at hand, but concerned about this whole idea that insurance companies can just eliminate hundreds of doctors and six hospitals, and what that means for the future,” Gill said.

A formal public hearing will be held Sept. 9 at the Burton M. Cross State Office Building in Augusta. Presentations by parties to the proceeding will begin at 9 a.m. Public comment will also be allowed during that hearing.

 

http://bangordailynews.com/2013/08/25/health/state-to-hold-public-comment-session-on-anthem-plan-that-puts-strict-limits-on-hospitals-doctors-that-policyholders-can-use/ printed on September 18, 2014