Maine bill aims to protect doctor-patient relationships, keep insurance companies from ‘practicing medicine’

Posted Feb. 05, 2014, at 5:41 p.m.

AUGUSTA, Maine — A bill before the Legislature’s Insurance and Financial Affairs Committee is designed to protect health insurance consumers by requiring more up-front disclosure on whether a new plan will cover a patient’s current doctor and medical facilities.

Co-sponsored by state Sens. Dawn Hill, D-Cape Neddick, and Margaret Craven, D-Lewiston, the bill, LD 1629, aims to make sure consumers and health care providers understand which hospitals and doctors are included in an insurance plan and why.

The bill is in part a response to “narrow network” proposals in 2013 by MaineHealth — owner of Maine Medical Center in Portland — and Anthem Blue Cross and Blue Shield that sought to exclude doctors and other providers in the Central Maine Healthcare system, which operate in Lewiston, Rumford and Bridgton. One proposal was approved by the state, the other was denied.

At stake is how far patients would have to go to see a doctor. In many cases, some say, an insurance company’s “narrow network” would mean patients would not only have to travel farther, but also would end up changing care providers altogether.

For the most rural patients the prospects are very frightening, Rep. Paulette Beaudoin, D-Biddeford, said during a work session on the bills earlier this month.

Beaudoin, who is turning 81, said the prospect of forcing elderly patients — or even young people — who don’t have a lot of money to travel great distances to get the care they expected when they purchased a health plan is discouraging.

“I have an awful, awful, feeling about all this and it makes me a little bit sick, and the more we are going into it, the sicker I’m getting,” Beaudoin said. She said she’s happy “I won’t be around too much longer to see what’s going to happen, because it makes me feel ill for the rest of the people.”

Beaudoin said most people who have serious health problems or chronic conditions are seeking doctors and treatment close to home.

“If they are like me, you try to find doctors that are right around you so you don’t have too far to go,” she said. “And you can’t afford a taxi and you can’t afford all this. People don’t have the money and it seems like this is being lost somewhere.”

The bill also requires health insurance providers to have a fair, transparent process when determining which hospitals will be “in network” hospitals.

“This is a matter of fairness,” Hill, the bill’s sponsor, said. “Insurance companies should be upfront about which hospitals they are including in their networks and why. This is a reasonable request to ensure patients and providers are informed about decisions that have a tremendous impact on Maine people and their medical care.”

In developing health insurance plans offered in the new marketplace created by the Affordable Care Act, Anthem excluded six hospitals from its list of “in network” hospitals.

The six excluded hospitals were York Hospital in York, Parkview Adventist Medical Center in Brunswick, Mercy Hospital in Portland, Central Maine Medical Center in Lewiston, Rumford Hospital in Rumford and Bridgton Hospital in Bridgton.

The bill sets up criteria for insurers so they would have to disclose who’s in and who’s out.

“We believe there should be some type of objective standards that insurance companies have to meet if they are going to offer health plans in Maine,” said Chuck Gill, a spokesman for Central Maine Healthcare, which includes Central Maine Medical Center. “We don’t believe insurance companies should be in the business of practicing medicine.”

During a public hearing on the bill in January, Craven said that by excluding “Central Maine Medical Center and its affiliates from their network, Anthem is requiring people who live in vast areas of the state to ignore all of their local providers and travel great distances to get medical care.”

The committee worked on the issue last week and is expected to take it up again Thursday when it meets at 1 p.m. in Room 220 of the Cross Office Building. The committee meeting is open to the public, but the committee has already taken public testimony on the bills.

 

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