Anthem, Northern Light Health Exchange Statements Over Contract Dispute

PRESQUE ISLE, Maine (WAGM) - Anthem Blue Cross and Blue Shield and Northern Light Health issued competing statements Wednesday regarding ongoing contract negotiations.

Anthem said Northern Light has “walked away” from mediation for the second time in two months. The insurer claims it has more than doubled its offer, now proposing a 5% increase for commercial business. According to Anthem, Northern Light continues to demand higher payments, which would total nearly $200 million over three years.

Anthem also stated Northern Light is seeking contract changes that would prevent the insurer from conducting audits of claims, which Anthem says are standard in the industry and protect customers from overpaying. The company said it is disappointed but remains open to compromise, while also preparing members for potential disruptions. Non-hospital facilities and providers with Northern Light are expected to leave Anthem’s commercial network on October 1, and the Medicare network on January 1.

Northern Light disputed Anthem’s account, calling the insurer’s statement “egregious misrepresentations.” Suzanne Spruce, Senior Vice President and Chief Marketing and Communications Officer, said Northern Light has not walked away from talks and remains committed to the mediation process. She said Anthem has refused to address contract language that Northern Light believes is necessary to protect the health system and its patients.

Both sides say they are open to negotiation, but no agreement has been reached.

Anthem statement:

“For the second time in two months, Northern Light Health has walked away from negotiations with Anthem, including abandoning the mediation process we both agreed to. While we have more than doubled our initial offer, now up to a 5% increase for Commercial business, Northern Light has reduced its demand only slightly, insisting that Mainers and employers increase payments by nearly $200 million over the next three years.

Northern Light Health is also asking Anthem to make a series of changes to our contract with them – such as preventing Anthem from continuing to conduct industry-standard audits of claims submitted to us. We use these audits, in part, to protect our customers from paying more than they should for their care. We cannot agree to this and other similar demands.

We are disappointed but remain open to further discussions and compromise. However, because Northern Light Health has decided not to continue with mediation, we are now continuing to help our members navigate care options. Northern Light Health intends for its non-hospital facilities and healthcare professionals to leave our Commercial network starting October 1, and our Medicare network starting January 1."

Suzanne Spruce, Senior Vice President and Chief Marketing and Communications Officer, Northern Light Health:

“Northern Light Health is disappointed to hear that Anthem publicly disseminated egregious misrepresentations of our mediation discussions. We have made no indication that we are walking away from negotiations and their statements are not constructive to the mediation process. Anthem refuses to address our requests for contract language that protects Northern Light Health and the patients we serve. We remain available for the scheduled mediations if Anthem changes its mind and wishes to provide language to address Northern Light Health’s concerns.”