anthem blue cross and blue shield - Maine.gov

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provider to participate in the network at a market rate within reasonable 1 quality
standards? One would have to assume that the answer is based2
on promises to the
“chosen” providers, rather than what is best for Maine consumers. 3
Q. Do you have any other concerns about the proposed Anthem network? 4
A. In addition to there being serious question about the adequacy 5of Anthem’s limited
network to accommodate these tens of thousands of new enrollees, 6 the Anthem network’s
exclusion of York Hospital and its providers will effectively prevent 7 southern York
County residents from having a choice of insurance carriers on8
the federal exchange.
These patients will effectively be limited to a single insurer.
And finally, I am concerned about the genesis and motive for10
creating the narrow, limited
networks that are at the heart of these plans. It is my understanding 11 that Maine Medical
Center and Maine Health have had and continue to wield significant 12 leverage in the
determination as to what hospitals and providers are included13
the Anthem network.
Also it is noteworthy that two of the hospitals which have been 14excluded from the
network are primary competitors of Maine Medical Center – Central 15 Maine Medical
Center and Mercy Hospital. A third is the only York County16
hospital that has not
affiliated with Maine Medical Center. If the inadequacies of 17 the proposed Anthem
network are in any way a function of an anti-competitive goal, 18we all should find that
especially troubling.
Additionally, the Blue Cross and Blue Shield Association for20
years has touted the
national coverage and access for members carrying a BCBS card. 21 This program known
as “BlueCard” allows a member to utilize ANY participating22
blue cross and blue shield
provider nationally. Certain language components mandated23
by the blue cross and blue
shield association are contained in our provider agreements today. 24 So how does a limited
provider network fit into this scheme? Presumably, according25
to contractual language
Anthem would have to allow any member to receive care from26
a participating blue cross
and blue shield provider, like York Hospital. However, they 27 will likely attempt to “steer”
patients away from York through benefit design and prior authorization 28 procedures
effectively suggesting to patients that medically necessary care 29cannot be rendered at
their local hospital. The concept of prior authorizations was never intended to
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