As you may have heard in the news, two large Southern Maine practices have recently notified patients that they have decided to withdraw from Anthem’s network, effective in late summer. Anthem has been negotiating with these organizations, but they have been unable to settle on a new contract.
The Health Trust is dismayed and concerned about the lack of access to these established providers, Coastal Women’s Healthcare and Fore River Urology. However, we do also understand that there is a balance to be maintained in order to control the costs of healthcare. Both organizations have asked for very large increases (between 50 to 70%) in the amounts they are paid for services provided.
State law requires that 60 days notice be provided to members if their doctor leaves the network. Anthem will be sending out letters to all impacted members if an agreement cannot be reached by that timeframe.
Under the Continuity of Coverage provisions, you may be able to stay with your current doctor(s) for a limited time 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 Coverage process, or in finding a new in-network provider if you so choose. Member Service representatives are available Monday through Friday form 8:00 a.m. – 4:30 p.m. at 1-800-852-8300.