Anthem can't make members switch docs, state regulator says

Anthem Blue Cross Blue Shield in Maine can't force its members to stop seeing their existing doctors who work for one of the state's hospital systems.

Maine Superintendent of Insurance Eric Cioppa reached that decision, concluding Anthem can't make its members switch to a narrow network plan it created with MaineHealth, the state's largest owner of hospitals and other providers, to sell on the health insurance exchange, the Lewiston-Auburn Sun Journal reported.

The primary problem with Anthem's plan, which excludes the three hospitals owned by Central Maine Healthcare and was widely slammed by the public, is that it isn't in the best interest of the insurer's current members who "would lose their existing contractual right to elect out-of-network care," Cioppa said, according to the Morning Sentinel.

Anthem should serve its members' interests by allowing them to select the narrow network plan instead of forcing them to participate in the plan and then opt out, "especially if the only way to opt out is to choose coverage from another carrier," he noted.

Cioppa's decision requires Anthem to redraft the plan to allow for an alternative to members whose doctors practice at the excluded hospitals. But Anthem said it hasn't yet decided how it will respond, insisting its narrow network plan is in the best interest for its members because it "offered a network with reasonable and comprehensive access to services at a premium that would have been 12 percent lower is in the best interest of our members," Anthem spokesman Christopher Dugan said, the reported the Portland Press Herald.

Anthem can choose to comply with the decision, appeal or comply under protest while filing an appeal.

To learn more:
- read the Lewiston-Auburn Sun Journal article
- see the Morning Sentinel article
- check out the Portland Press Herald article

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