Maine Superintendent of Insurance Eric Cioppa has decided Anthem Blue Cross and Blue Shield cannot make customers in the state change healthcare providers under a new, narrow-network insurance plan, according to a Portland Press Heraldreport.
Anthem and Portland, Maine-based MaineHealth — the state's largest health system — intended to form an insurance network including 32 of the state's 38 hospitals to offer coverage through the new exchange that will open this fall under the Patient Protection and Affordable Care Act. The Maine Bureau of Insurance approved the proposed network in July.
However, last month, hundreds of state residents at a public hearing criticized Anthem's plan to shift about 9,000 enrollees to the new plan. Lewiston-based Central Maine Medical Center has said the plan puts insurance consumers in the central and western part of the state at a disadvantage, since they would have to travel farther to reach physicians.
Anthem defended the plan at a hearing held by the state insurance bureau, saying less than 10 percent of the insurer's individual subscribers use specialists and primary care physicians who aren't included in the new network. The insurer also said the plan will cost enrollees about 12 percent less than a broader plan would.
However, Mr. Cioppa's decision means Anthem must restructure its plan that imposes fewer restrictions on policyholders in southern and western Maine, according to the Herald. Anthem hasn't responded to questions about Mr. Cioppa's decision, according to the report.
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