Close
Menu

News Feed

May 26, 2022

Bookmark and Share

Important Information Regarding Anthem Provider Contracting Disputes

Important Information:

  • The MEA Benefits Trusts is a not-for profit employee welfare benefit plan dedicated to the health of Maine public school employees and their families.
  • The MEABT contracts with Anthem to offer health insurance to approximately 68,000 active and retired educators, support staff and their dependents in the K-12 schools throughout Maine.
  • Our active and retiree medical and prescription benefits are insured by Anthem.
  • It is a carrier role to negotiate and contract a fair and reasonable level of reimbursement directly with provider practices as well as facilities for the services they provide.
  • The contracted reimbursement rate for services provided by in-network providers to our members directly correlate to the premium rates associated with our plans and protects our members from balance billing.
  • The MEA Benefits Trust had completed the renewal of our plan for the July 1, 2022 plan year and our Board of Trustees approved the renewal on March 24, 2022.
  • Premium rates were released to all participating school districts on the morning of  April 6, 2022.

Maine Medical Center

  • Shortly after releasing the rates on April 6, the CFO of MaineHealth contacted the Trust to notify us of their intent to terminate Maine Medical Center’s provider contract effective January 1, 2023.  It’s important to note that this notice to terminate was in the middle of a 3-year contract between MMC & Anthem.
  • The premium rates effective July 1, 2022 were developed based on MMC being in-network and reimbursed at the negotiated contract rate.
  • The MEA Benefits Trust has encouraged compromise and flexibility by both parties, to reach a resolution that is, first and foremost, in the best interests of their patients and our members.
  • The MEABT continues to meet regularly with both parties to express our concerns and the importance of resolution to this contract dispute on behalf of all of our members.
  • The MEABT is working with Anthem to develop contingency plans to minimize disruption to our membership in the event a resolution has not been reached.
  • The MEABT has solicited input from the Bureau of Insurance in understanding the implications to our members in the event MMC becomes a non-contracted provider effective January 1, 2023.

Fore River Urology and Coastal Women’s Healthcare

  • On May 2, the MEABT received notice that Fore River Urology would be leaving the Anthem commercial network effective August 1 and their Medicare Advantage network effective September 1.
  • According to Anthem, Fore River Urology is requesting an increase in their reimbursement in excess of 50%.
  • On May 24, the MEABT received notice that Coastal Women’s Healthcare would be leaving the Anthem provider network effective August 23, 2022.
  • According to Anthem, CWHC is requesting an increase in their reimbursement in excess of 70%.
  • Both Fore River Urology and CWHC had been in normal negotiations for a renewal of their participating provider agreement.
  • Both practices are an important part of Anthem’s provider network and we believe they should be compensated fairly for the care they give our members.
  • We are disappointed that both physician practices have walked away from negotiations by announcing an intention to leave the Anthem network, understandably causing concern among our members.

Action Steps

  • As with all potential provider terminations, we understand that members will be concerned about continuity of care.  The Trust is working Anthem on continuity of care plans for members actively being managed by providers within these practices as well as Maine Medical Center in the event that agreements aren’t reached by their associated deadlines.
  • The Trust regularly goes through a Request for Information/Request for Proposal (RFI/RFP) process to evaluate carriers and make decisions on the best carrier to administer our benefits.
  • The overall structure of the MEA Benefits trust is very complex and therefore the RFI/RFP process used to evaluate carriers requires a comprehensive, in-depth analysis.  It is imperative when evaluating carriers that every options is fully vetted to ensure the highest level of coverage is available to our members at the best price.
  • As part of our normal course of business, the MEABT will be initiating the RFP process this summer.

We recognize that the multiple provider contract disputes currently going on with Anthem have created unrest and uncertainty for our members.  It is important to note, that all of these negotiations are complex and disagreements on reimbursement between providers and carriers is not unique to Anthem.  The Trust expects our insurance partner to negotiate fair compensation to providers and to maintain a balance between access to quality care and cost and we continue to work with them to ensure that result. 

We will continue to monitor this situation closely and as additional updates are received and as continuity of care plans and contingency plans become finalized, we will be sure to share this information.

Thank you,

Jennifer Kent

Executive Director

MEA Benefits Trust

May 24, 2022

Bookmark and Share

Coastal Women's Healthcare

The MEABT was informed on Tuesday, May 24 that Coastal Women’s Healthcare had sent a termination notice to Anthem.  The notice stated that effective August 23, 2022, Coastal Women’s Healthcare will no longer be a participating provider in Anthem’s provider network.   Anthem and Coastal have been in negotiations for a renewal of the participating provider agreement.  Coastal Women’s Healthcare provides quality, personalized care and we consider them to be an important part of Anthem’s care provider network. We believe they should be compensated fairly for the care they give our members and that has been Anthem’s goal in negotiations with them. According to Anthem, they have offered them generous increases over the next several years, which Coastal has rejected. Anthem has also offered a one-year extension with a substantial increase in rates to provide time to finalize a longer-term deal, which they also turned down. Again, according to Anthem, Coastal Women’s is insisting on a 70 percent increase in reimbursement rates, which Anthem cannot agree to because it will greatly impact affordability for its members.

It’s extremely disappointing that Coastal Women’s Healthcare has chosen to walk away from negotiations by announcing an intention to leave Anthem’s network, understandably causing concern among consumers. We urge them to re-engage in good faith negotiation efforts with Anthem so our members can continue to receive the care they rely on from Coastal Women’s Healthcare.

As with all potential provider terminations, we understand that members will be concerned about continuity of care.  This is especially so with providers who are managing a member’s pregnancy.  The Trust will be working with Anthem on continuity of care plans for members actively being managed by providers within this practice in the event that an agreement is not reached by the August 23 deadline.  We will continue to monitor this situation closely and share any additional information to assist our members as we learn more. 

We recognize there are multiple provider contract disputes currently going on with Anthem and the unrest and uncertainty this creates for our members.  The Trust expects our insurance partner to negotiate fair compensation to providers and to maintain a balance between access to quality care and cost and we continue to work with them to ensure that result. 

As additional updates are received and as continuity of care plans and contingency plans become finalized, we will be sure to share this information.

 

April 29, 2022

Bookmark and Share

GASB 75 Recorded Discussion

Third Year Reporting Discussion for GASB 75

April 18, 2022

Bookmark and Share

Message from Anthem Regarding Maine Medical Center Network Termination Announcement

Anthem Blue Cross and Blue Shield

 

We are working with MaineHealth to keep Maine Medical Center in your plan's network

 

Our top priority is making sure you can get the care you need at an affordable cost. We are disappointed that MaineHealth announced they will remove Maine Medical Center from our care provider network on January 1, 2023. This is almost two years before our contract with them runs out.

You can still go to Maine Medical Center for care right now
It is in your plan's network through December 31, 2022. We are working with MaineHealth and hope to reach an agreement that keeps Maine Medical Center in your plan's network beyond December 31.

MaineHealth price increases affect your healthcare costs
We have worked with MaineHealth for many years. But in the last few years, we have disagreed with them about unauthorized, increased charges at Maine Medical Center. These increases violated our provider agreement with them and have resulted in higher costs for Anthem members and other consumers who receive care there.

We routinely audit billing practices at hospitals in our network. This is part of our commitment to provide you access to quality affordable care. In 2018, an audit showed Maine Medical Center was overbilling for anesthesia and operating room care. We worked with MaineHealth to identify the Anthem members they overcharged. They acknowledged overcharging our members and issued nearly anthem-maine-medical-center0 million in refunds.

Recently, another routine audit found that MaineHealth has again overcharged consumers for care. Anthem and MaineHealth are working with an independent mediator to help resolve this issue.

We are ready and willing to work with MaineHealth. We hope they will join us in working to provide affordable care at Maine Medical Center.

You can go to Maine Medical Center if you need emergency care, even if it leaves our network
Call 911 right away or go to the nearest emergency room (ER) if you are having a medical emergency. If Maine Medical Center is your closest ER, go there. Your plan covers emergency care at your in-network benefit level no matter where you receive it.

If you are in ongoing treatment at Maine Medical Center in December, we will work with you
You can still receive care at Maine Medical Center through December 31, 2022. If we don't reach an agreement with MaineHealth, we will work with you to make sure you have access to the care you need.

We are here to help
Please visit anthem.com/mmc for updates or call the Member Services number on your Anthem ID card.

Thank you for trusting Anthem with your healthcare plan.

— Your Anthem team

April 11, 2022

Bookmark and Share

Message from the MEA Benefits Trust

I’m writing to you today regarding MaineHealth’s announcement last week concerning Maine Medical Center’s notice of intent to terminate its provider network contract with Anthem at the end of the year.   We have been, and continue to be in contact with both parties and have expressed our sincere concerns.  We continue to encourage both sides to work out their differences and resolve this dispute.  Termination of this contract would be unprecedented and harmful not only to our members but to a large percentage of the residents of Maine. We continue to hope that both parties will put the interests of the their patients and their members first and use their best efforts to reach an agreement and keep Maine Medical Center in the Anthem network.  Please be assured that the MEA Benefits Trust and it’s advisors are monitoring this situation very closely and are working on contingency plans in the unfortunate event an agreement cannot be reached.  

 

It is important to note that this contract dispute does not impact our Medicare Advantage retirees.  Our Medicare Advantage plan is a passive PPO plan, which means the plan pays the same benefit, regardless of whether the provider is in or out-of-network, so long as the provider accepts Medicare and the plan.  We have no reason to believe that MMC will not continue to participate with Medicare and accept Medicare Advantage plans.

 

Anthem has launched a microsite where members can go to get the latest information from Anthem.  The microsite is www.anthem.com/mmc.  Within the FAQ document on this site, Anthem makes the following statement:  “At this point, it is unclear if MaineHealth’s actions will impact Medicare Advantage members, including those with Anthem I MaineHealth Medicare Advantage plans.”  Anthem’s reference to Medicare Advantage members is specific to individual Medicare Advantage products sold by Anthem and not our group Medicare Advantage plan.  We recognize this statement by Anthem may create unnecessary concerns for our members, which is why we want to be clear that this dispute does not impact our MEABT Medicare Advantage members.

I’m writing to you today regarding MaineHealth’s announcement last week concerning Maine Medical Center’s notice of intent to terminate its provider network contract with Anthem at the end of the year.   We have been, and continue to be in contact with both parties and have expressed our sincere concerns.  We continue to encourage both sides to work out their differences and resolve this dispute.  Termination of this contract would be unprecedented and harmful not only to our members but to a large percentage of the residents of Maine. We continue to hope that both parties will put the interests of the their patients and their members first and use their best efforts to reach an agreement and keep Maine Medical Center in the Anthem network.  Please be assured that the MEA Benefits Trust and it’s advisors are monitoring this situation very closely and are working on contingency plans in the unfortunate event an agreement cannot be reached.  
It is important to note that this contract dispute does not impact our Medicare Advantage retirees.  Our Medicare Advantage plan is a passive PPO plan, which means the plan pays the same benefit, regardless of whether the provider is in or out-of-network, so long as the provider accepts Medicare and the plan.  We have no reason to believe that MMC will not continue to participate with Medicare and accept Medicare Advantage plans.
  
Anthem has launched a microsite where members can go to get the latest information from Anthem.  The microsite is www.anthem.com/mmc.  Within the FAQ document on this site, Anthem makes the following statement:  “At this point, it is unclear if MaineHealth’s actions will impact Medicare Advantage members, including those with Anthem I MaineHealth Medicare Advantage plans.”  Anthem’s reference to Medicare Advantage members is specific to individual Medicare Advantage products sold by Anthem and not our group Medicare Advantage plan.  We recognize this statement by Anthem may create unnecessary concerns for our members, which is why we want to be clear that this dispute does not impact our MEABT Medicare Advantage members.

Jennifer Kent

Executive Director