After many months of negotiations, Northern Light and Anthem have finally agreed upon a new contract, allowing patients to continue receiving in-network coverage for their care.
Details of the contract have not been released, but the agreement will be applied retroactively to November 1, meaning that all care from Northern Light will be considered in-network by Anthem regardless of when the services were rendered.
Northern Light and Anthem’s new contract will be valid for the next three years.
On October 31, the previous contract between the two organizations came to an end following the adoption of a one-month extension, leaving many Mainers out-of-network and facing the possibility of higher out-of-pocket costs for their medical care.
At the time, Northern Light told patients insured through Anthem that they would not submit any bills to the insurance company until a deal was struck in order to help them avoid incurring costs for seeking care that is currently outside of their network.
That said, the two companies had not agreed to another formal extension, meaning that as far as Anthem was concerned, all care at Northern Light was outside of their network.
Over the past several months, Northern Light and Anthem have repeatedly failed to agree on a workable path forward, publicly feuding over reimbursement rates and each calling the other unreasonable.
While Northern Light had accused Anthem of undercutting them financially, the insurance provider intimated that the health care system’s demands would cause millions of dollars in cost increases for other Anthem members over the life of Northern Light’s proposed three-year agreement.
According to Northern Light, Anthem has only increased their reimbursement rates by less than an average of 1.5 percent annually, failing to keep pace with the average 7.5 percent inflation rate in the industry.
Anthem, on the other hand, has argued that Northern Light wants to implement a 30 percent price increase, creating an estimated $218 million in new healthcare costs, most of which they say will fall on the shoulders of patients and employers in the form of co-payments and premiums.
Northern Light has painted Anthem as unwilling to keep up with rising costs, while Anthem has framed Northern Light as wanting to drastically increase costs for patients.
Although their contract was originally set to expire at the end of September, the two agreed to a one-month extension, allowing Mainers insured through Anthem to remain in-network through Halloween.
When that new deadline came and went without the two reaching an agreement, however, the prior contract between Northern Light and Anthem officially lapsed.
Going into the new month, the health care system released a statement articulating its plans for accommodating patients insured by Anthem while the two continue to work toward a deal.
At the time, Northern Light promised to make any contract with Anthem retroactive so that all care provided would be billed as in-network, regardless of when the services were rendered.
“Northern Light Health continues to work through mediation with Anthem to reach a new contract,” the statement said, according to WABI. “Until we reach a final decision, we will be holding all bills for any patient care that has occurred outside of our final contract date of Friday, October 31.”
“Patients with Anthem insurance plans will not be billed for any services until the completion of this negotiation,” they explained. “In the event an agreement is reached, we will ensure the contract is retroactive, so that any care provided during this period will be billed at in-network rates.”
“We remain committed to serving all in the state of Maine who need us, and we continue to work closely with Anthem to conclude negotiations as soon as possible,” Northern Light added.
Anthem shared a statement of their own with WABI regarding the situation, emphasizing that all Northern Light non-hospital facilities and healthcare professionals were considered to be out-of-network at the time for anyone insured through their commercial plans.
“According to Northern Light, members will not be treated as out of network and will be held harmless, but Northern Light refuses to sign an extension that will allow that to happen,” said Anthem.
“If Northern Light Health agrees to a contract or an extension, all facilities and services will again be in network,” Anthem wrote. “If they won’t agree to an extension, claims for professional and non-hospital services submitted on or after November 1, 2025, will process as out-of-network, except for specifically approved situations, such as continuity of care.”
“Northern Light Health’s hospitals remain in network for all Anthem members through December 31,” continued Anthem. “At this time, however, Northern Light’s latest request on hospital prices continues to exceed what we can ask our members and employer customers to pay.”
“We are focused on having Northern Light Health in our network at prices our members and employers can afford,” they said.
Anthem then went on to list several reasons why they wanted to see a formal extension of their contract with Northern Light, including to help reduce confusion and avoid patients incurring incorrect charges.
“We continue to offer an extension to Northern Light, but they refuse — and we don’t know why since they are saying they are willing to treat patients as in-network,” said Anthem. “Nonetheless, we can sign that extension today if they are willing to do so.”
This prompted Northern Light to release a follow-up statement in which they reiterated their commitment to helping patients avoid out-of-network costs while the two continue their negotiations.
“I personally want to reassure our patients who are Anthem customers that they can continue to receive care with Northern Light Health, without disruption while these negotiations continue – they will not be treated as out of network,” said Northern Light Health President and CEO R. Guy Hudson, MD.
“We are committed to their health and care, which is why we are dedicated to a contract that protects the services they need,” he added. “We are proud to serve our communities and appreciate your patience and understanding as this process concludes.”
Because an agreement has now been reached between Northern Light and Anthem, all care that patients have already received, and will continue to receive, from the health care system will be considered in-network by the insurance company.
Northern Light has indicated that they will be contacting patients insured through Anthem to alert them that in-network access will now continue without disruption.
Patients are encouraged to contact the appropriate Northern Light facility or department with any questions, or to call the dedicated community information line at 1-888-616-0039.
