Anthem wins state regulatory approval to create narrow network plan


Anthem Blue Cross Blue Shield can move forward with its plan to partner with Maine's largest provider network in offering a new limited network policy available on the state's health insurance exchange.

The Maine Bureau of Insurance approved the new Anthem-MaineHealth plan, which includes 32 of Maine's 38 hospitals as in-network providers. But Anthem has drawn criticism for omitting one of the state's hospital systems, Central Maine HealthCare, from its network, the Bangor Daily News reported.

In its approval, the bureau outlined 14 conditions Anthem must meet, including submitting more information on the plan's effect on access to care, contracting with more specialists in some areas and reporting on consumers' future experience with the plans.

"Overall, I find Anthem's network--with the modifications and conditions imposed herein--to be capable of providing 'reasonable access to health services,'" Superintendent of Insurance Eric Cioppa said in the order, according to the Portland Press Herald. "If the access provided is reasonable, it is irrelevant that the network could be bigger or better."

But the bureau cautioned Anthem from switching some current members to the new narrow network plan, a move the insurer has been considering, reported the Maine Public Broadcasting Network. Cioppa said that decision will be made after a hearing next month where Anthem must demonstrate switching members provides a corresponding benefit to customers and "presumably lower rates."

The Anthem-MaineHealth still requires federal approval before it's available on the exchange. Meanwhile, Central Maine Health Care is considering whether to appeal the bureau's decision.

To learn more:
- read the Portland Press Herald article
- check out the Bangor Daily News article
- see the Maine Public Broadcasting Network article

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