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Northern Light Health Cuts Ties with Anthem Over Payment Delays and Authorisation Hurdles

WABI-TV

Maine's Northern Light Health has officially ended its contract with Anthem Blue Cross and Blue Shield, citing ongoing issues with payment delays and a cumbersome prior authorisation process. The decision, announced recently, marks a significant shift in healthcare partnerships within the state and has raised concerns about potential impacts on patient care.

According to Northern Light Health representatives, Anthem's reluctance to release interim payments for services already rendered, coupled with a strict and often slow prior authorisation process, created substantial obstacles for delivering timely and effective care to patients. These challenges reportedly diverted valuable time and resources away from direct patient interaction, impacting the overall quality of care.

“We’ve been working diligently with Anthem to resolve these issues for some time,” stated a spokesperson for Northern Light Health. “However, despite our best efforts, the problems persisted, creating an unsustainable environment for our providers and ultimately jeopardising patient care. This wasn’t a decision we took lightly, but we believe it’s in the best interest of our patients and our staff.”

The Prior Authorisation Process: A Major Pain Point

A key source of frustration has been Anthem’s prior authorisation process. This system requires healthcare providers to obtain approval from Anthem before certain procedures, medications, or tests can be performed. While prior authorisation is a common practice in the healthcare industry, Northern Light Health claims Anthem’s process was excessively complex and time-consuming, leading to delays in necessary treatment and increased administrative burden.

“The sheer volume of authorisations required, combined with the lengthy turnaround times, was overwhelming,” explained Dr. Emily Carter, a physician at Northern Light Eastern Maine Medical Center. “We would spend hours each week simply chasing down authorisations, taking away from the time we should be spending with patients. It was incredibly frustrating and, frankly, detrimental to patient care.”

Impact on Patients and Future Plans

The immediate impact of this contract termination is that Anthem members seeking care at Northern Light Health facilities may face disruptions. Northern Light Health is working to ensure a smooth transition for patients and is actively communicating with Anthem to minimise any inconvenience. They are also exploring alternative insurance partnerships to ensure continued access to care for their patients.

“Our priority remains providing high-quality care to all our patients,” assured the spokesperson. “We are committed to working with Anthem and other payers to find solutions that support a sustainable healthcare system and ensure patients have access to the services they need.”

What does this mean for other healthcare providers in Maine? This decision by Northern Light Health could set a precedent for other healthcare providers in Maine facing similar challenges with insurance companies. It highlights the growing pressure on providers to balance administrative demands with the delivery of patient-centered care. Observers suggest that this situation could lead to increased scrutiny of payer practices and a renewed focus on streamlining administrative processes within the healthcare system.