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After negotiations break down, Northern Light severs ties with Anthem

orange tinted aerial of building facade and flag FILE PHOTO / COURTESY NORTHERN LIGHT HEALTH Northern Light Health cut ties to Anthem Blue Cross Blue Shield after the two organizations failed to reach a contract agreement.
By Laurie Schreiber

Northern Light Health said it would end its ties to Anthem Blue Cross Blue Shield after the two organizations failed to reach a contract agreement.

Factors contributing to the decision included what Northern Light said were delays in claims processing and a high volume of denials, a cumbersome prior authorization process, redundant and non-standardized forms and unclear communications.

“These tactics are increasing the amount owed to Northern Light Health by Anthem, putting real financial strain on our health care system,” Timothy Dentry, the system’s president and CEO, wrote in an Aug. 15 letter to Denise McDonough, president of Anthem Blue Cross and Blue Shield at its South Portland office.

Over the past year, nearly 50,000 of Anthem members in Maine have used at least one service from Northern Light Health, an Anthem spokesperson told Mainebiz.

Anthem statement

“We at Anthem are disappointed to learn that Northern Light Health is indicating they will discontinue negotiations — with several weeks and months to go before their contracts with Anthem are supposed to terminate,” Anthem said in a statement emailed Monday to Mainebiz.

The statement continued, “We remain committed to working with Northern Light to reach a new contract in the weeks ahead. It’s the right thing to do for our members who are Northern Light patients. So, we intend to keep the lines of communication open.”

Inadequate reimbursements

In June, James Rohrbaugh, executive vice president and chief financial officer at Northern Light, told Mainebiz that Anthem’s reimbursements have not kept pace with the annual inflation rate for health services.

Northern Light said the insurer has been paying its hospitals and clinics 15% less for outpatient care and 24% less for inpatient care than other Maine health care providers.

Anthem, the largest commercial insurer in the state, is operated by Elevance Health, a publicly traded, for-profit corporation that’s one of the largest for-profit insurance companies in the country, according to a news release.

Northern Light said would reconsider its decision if Anthem “comes back with a reasonable offer,” the release says.

Effective Oct. 1, Northern Light Health will be out of network with Anthem for physicians and some ancillary services. Effective Dec. 31, the system will be out of network with Anthem hospital-based services. 

Effective Jan. 1, 2026, Northern Light Health system, including hospitals, clinics and physicians, will be out of network with all Anthem Medicare Advantage plans. 

Emergency care is always covered, at the in-network cost-sharing level, no matter the contract status with Anthem.

For more information, click here or contact AnthemQuestions@NorthernLight.org or 1-888-616-0039.  

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