All of us at Anthem Blue Cross and Blue Protect in Maine are deeply dedicated to offering our 300,000 members entry to prime quality, outcomes-driven well being care. We consider MaineHealth shares these targets. The place our two views diverge, nonetheless, is that our work facilities on guaranteeing that care is inexpensive.
Anthem workplaces in South Portland. Well being care in Maine will be so costly that some employers discover it cheaper to ship staff to Boston for sure surgical procedures or care, in accordance with Denise McDonough, president of Anthem Blue Cross and Blue Protect in Maine. Shawn Patrick Ouellette/Employees Photographer
The truth is, well being care prices in Maine are excessive – a few of the highest within the nation – and if we’re not vigilant, they’ll proceed to climb greater. An goal 2019 study by the University of Pennsylvania ranked Maine as having the fourth highest well being care price burden for working households in America, and a 2020 study by the Rand Corp. confirmed costs paid to hospitals in Maine by non-public insurers are 252 % of what Medicare would have paid for a similar companies on the identical amenities.
The end result? Maine will be such an costly state for well being care that some employers discover it cheaper to send their employees to Boston for sure surgical procedures or care.
The findings of those research and others don’t come as a shock to me, nor to Maine employers and shoppers. Nearly all of our members in Maine work for firms which can be self-funded, which implies an insurer like Anthem administers the plan, however the employer pays for well being care prices instantly; any will increase well being programs cost for medical bills is a direct enhance within the bills they pay. Employers with “conventional” plans, the place the insurer assumes the dangers and the prices, see their premiums enhance as prices go up.
Merely put, the costs well being programs cost for companies is the first driver of well being care spending. If the price of companies continues to rise unchecked, all Mainers pays extra for well being care by means of greater premiums and better out-of-pocket prices. If that sounds unsustainable, that’s as a result of it’s.
At Anthem, our function is to guard our prospects from elevated prices and to guard affordability for the companies and folks we serve. That’s the entire motive why we enter into contractual relationships with suppliers and well being programs: to be stewards of our prospects’ cash.
Commercial
Our work is as necessary now as ever. By way of routine audits, we found MaineHealth has overcharged our members. In 2018, we found overbilling by Maine Medical Middle in Portland for anesthesia and working room companies. Because of an investigation, MaineHealth ultimately acknowledged the overcharging and issued refunds amounting to almost $20 million. If it weren’t for our inner audits – a system of checks and balances to guard our members – these overcharges might by no means have been found.
Sadly, we discover ourselves in an analogous state of affairs, the place by means of a routine audit, it was found that MaineHealth has as soon as once more overcharged Maine consumers and charged them for companies they shouldn’t have, which we consider totals tens of millions of {dollars}. Disputing such fees is on the coronary heart of the present dispute with MaineHealth.
Anthem has been companions with MaineHealth for many years, and to ensure that all Mainers to have entry to high-quality, outcomes-driven well being care, we consider strongly that this partnership should proceed. To assist resolve these issues with MaineHealth, we’ve engaged an impartial mediator.
As, respectively, the biggest payer and supplier within the state, Anthem and MaineHealth have a accountability to deal with the challenges of rising well being care prices on behalf of the folks we mutually serve. We at Anthem Blue Cross and Blue Protect agree with the governor that it’s in one of the best pursuits of shoppers to return again to the negotiating desk and hash out our variations. I’m dedicated to doing so, as are the a whole bunch of Mainers I work with every single day. We’re hopeful MaineHealth will be a part of us.
Associated Tales
Invalid username/password.
Please verify your electronic mail to verify and full your registration.
Use the shape under to reset your password. While you’ve submitted your account electronic mail, we are going to ship an electronic mail with a reset code.