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Maine: Anthem can’t force patients to change doctors

Maine Superintendent of Insurance Eric Cioppa ruled last week that Anthem Blue Cross and Blue Shield will have to redesign the narrow network of the health plans it is selling on the federal insurance marketplace, out of concern that too many patients would lose access to their current doctors, according to the Maine Sunday Telegram .

The network for the plans on the marketplaces, a key part of the federal Affordable Care Act, will exclude six of the state’s 38 hospitals, which means as many as 9,000 people may have to switch doctors under Anthem’s original proposal, according to the Telegram’s report.

Cioppa’s decision Friday was mixed: He approved the proposed network in six counties, but denied it in 10 southern and western counties.

In those counties, Anthem must either renew the existing coverage with changes only to make the plans meet the requirements of the Affordable Care Act, or allow policy holders to buy plans with the existing broad network, according to the Telegram.

Anthem has proposed a similar narrow network for its marketplace plans in New Hampshire, excluding Concord Hospital and nine more of the state’s 26 hospitals.

In Maine, Anthem is one of two companies selling insurance on the new marketplace, basically a web site where residents in each state can purchase insurance and receive tax subsidies to help defray the cost if they are eligible.

Anthem is the only company selling plans for 2014 on New Hampshire’s marketplace. The proposed network has been recommended by the state Insurance Department and approved by the federal office overseeing the new insurance marketplaces.

Anthem representatives have said roughly 10 percent of their customers next year will be on the limited network, but it is unclear how many will lose access to their current providers.

Anthem representatives have said the limited networks allowed them to negotiate lower reimbursement rates with providers, without which premiums could have been 30 percent higher.

(Sarah Palermo can be reached at 369-3322 or or on Twitter @SPalermoNews.)

Legacy Comments2

Companies know full well that Single Payer will not work, will go broke and then progressives like you will be saying: "We need to tax corporations more, they are getting away without having to provide insurance for their people". Think Elizabeth Warren and Barack Obama..."you did'nt build this".....idiots all........I read today where companies will now use boutique insutance to attract people.

We can't have it both ways. We can't rely on the free market for our health insurance, then complain/sue when the free market doesn't do it the way we want them to. Single-payer insurance, de-coupled from employment, is the way to go. (Why doesn't the corporate world jump at the possibility of divesting themselves of the responsibility of providing health insurance? Why?)

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