MAINE, USA — Two of Maine's health care systems reached a deal with one of the country's largest health insurance providers Wednesday to avoid a lapse in in-network coverage for patients.
Covenant Health, which owns St. Mary's Health System in Lewiston and St. Joseph Healthcare in Bangor, announced Wednesday afternoon that it had reached an agreement with Anthem Blue Cross Blue Shield insurance to keep the provider's coverage in-network.
On Monday, Covenant started notifying patients that it had not yet reached a deal with Anthem and that the company would stop accepting Anthem in-network as of July 5 if a deal was not reached. The two sides agreed Wednesday afternoon.
"We appreciate the patience Anthem members throughout Maine have shown during this process," Stephen J. Grubbs, President/CEO of Covenant Health, said in a press release. "We are confident the extra time we spent in discussions with Anthem helped ensure we have the resources necessary to provide Mainers with the highest quality care and best patient experience possible."
Covenant said it started these discussions back in October.
"In addition, our discussions have opened dialogue on ways that we can work together to streamline the claims process and reduce paperwork for our providers and patients alike. As always, we are deeply grateful for the trust our patients have placed in us and for the opportunity to care for those who need it most."
“Our members remained our No. 1 priority as we worked hard to come to an agreement that protects access to high-quality care for Mainers that is also affordable,” Denise McDonough, president of Anthem Blue Cross and Blue Shield in Maine wrote in a statement. “We have a great opportunity to work more closely with Covenant Health to streamline how our two organizations share clinical information to ensure more efficient, coordinated care. We’re pleased to continue our partnership and ensure Anthem members have access to Covenant Health providers for the next years to come.”
MaineHealth, one of the state's largest health care systems, dealt with similar negotiation issues in 2022. The two sides reached a deal in August 2022.
The Maine Bureau of Insurance is performing a Market Conduct Exam of Anthem in Maine. Market conduct examinations generally involve numerous requests for various data sets and other documentation followed by a lengthy period of analysis of extensive amounts of data, according to Maine Bureau of Insurance spokesperson Judith Watters.
"Substantial time is required for an accurate and thorough review. We are not able to predict an end date, but a public report will be issued when the exam concludes," she wrote in an email in August of 2022.
The BOI's market conduct exam began in early 2022.