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September 10, 2013

Anthem makes case for its ‘narrow network’ plan

Anthem Blue Cross and Blue Shield representatives made the case Monday for their plan to move about 9,000 individual health insurance customers to a new insurance product they will offer with MaineHealth on the state’s Affordable Care Act marketplace next month, according to the Portland Press Herald.

The insurer has received criticism for limiting the scope of its new insurance plan, particularly from hospitals not included in the network, like three hospitals owned by the Lewiston-based Central Maine Healthcare, Mercy Hospital in Portland, Parkview Adventist Hospital in Brunswick and York Hospital in York. The Anthem plan includes 32 of the state’s 38 hospitals.

Executives from MaineHealth and St. Mary’s Regional Medical Center told state regulators Monday that they agreed to take lower reimbursement rates from Anthem in exchange for that insurer directing more of its policyholders to their hospitals. Specific details of that contract were not disclosed.

Anthem told officials from the state’s Bureau of Insurance that about 9,000 of its policyholders would be switched and around 1,000 of those people — less than 10% of its individual policyholders — would have to change either the primary care providers or specialists they use, as a result, if they stick with Anthem’s plan.

When the marketplace plans become available Oct. 1, Anthem’s plan will compete with another from the nonprofit Maine Community Health Options, which has proposed a network of 34 hospitals. The insurers Mega Life and Harvard Pilgrim will also continue to offer individual plans outside of the marketplace.

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