Covenant Health, which operates St. Joseph’s hospital in Bangor and St. Mary’s hospital in Lewiston, has been negotiating a new contract with Anthem. Covenant stated in early May that unless an agreement can be reached, they will remove their physicians, providers, and other facilities in Maine from the Anthem provider network, effective July 5, 2023.
While negotiations are ongoing, no agreement has been reached at this time. We are hopeful that an agreement will be reached soon, but we are ready to assist members when and if these providers and facilities leave the Anthem network.
The Health Trust is concerned about the potential lack of access to these established providers and hospitals, and we understand that members may be anxious about disruption with their current providers. However, we also recognize that there is a balance to be maintained in order to control the costs of healthcare. Covenant has asked for very large increases in the amounts they are paid for services provided, and these costs are shared by all Health Trust members.
Anthem has created a website to share updated information about this matter at https://www.anthem.com/covenantmaine/.
In early May, Anthem sent out letters to all members who utilized a Covenant Health provider within the past 12 months. Members on a Health Trust POS plan who currently see a Covenant Health primary care physician (PCP) will also be receiving letters shortly assigning them to another, non-Covenant provider and subsequently a new ID card listing the new PCP. If you receive a letter and would like to change your PCP to another in-network provider, please contact Member Services for assistance with this process. Please note that members on a Health Trust PPO plan are not required to have a PCP under their plan and therefore will not receive a letter assigning them to another non-Covenant PCP. However, if you continue to see a Covenant Health PCP after July 5, 2023, your benefits will be paid at the out-of-network level.
Under the Continuity of Care provisions, you may also be able to continue treatment with your current doctor(s) for a limited time past July 4th, if you are receiving certain types of care.
Under federal law, this includes care if you are:
- In treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment in order to avoid death or permanent harm. It can also be an ongoing (chronic) illness that is life threatening or potentially disabling and requires specialized care over a long period of time.
- In a hospital or other inpatient facility.
- Scheduled for nonelective surgery by your current doctor, including your post-operative care for the surgery.
- Terminally ill.
Please contact MMEHT Member Services so that we can assist you with the Continuity of Care process, or with finding a new in-network provider if you so choose. Member Service Representatives are available Monday through Friday from 8:00 a.m. – 4:30 p.m. at 1-800-852-8300.