Letter to the editor: Anthem and MaineHealth are both responsible for the exorbitant costs
As a former board member of Share Health Plan, precursor to United Health Care, and former president and CEO of a suburban Boston hospital, I bring a unique perspective to the conflict between MaineHealth and Anthem insurance (“$136 fee for $2 saline solution? Anthem, MaineHealth Commercial Liability,” April 17, page A1). From my perspective, both organizations are to blame and both organizations are deceiving patients, providers and the State of Maine.
For 40 years, I have watched healthcare organizations routinely inflate the cost of services by 100, 500, even 1000%. Insurance companies generally did not complain, as these costs were passed directly to the consumer as premiums increased.
Insurance companies play a different game. Although not commonly known, a certain percentage of claims are automatically rejected when first submitted, forcing the patient and/or provider to resubmit a lengthy review process. In the meantime, the initial premiums paid to insurers are available for investment. The system is bankrupt and demonic.
For the past 18 months, I have served on the board of directors of Maine Healthcare Action, a nonprofit that unsuccessfully tried to reach a decision in the November 2022 ballot that required the Maine Legislature to pass a universal, single-payer health care plan by 2024. Hundreds of Mainers will are volunteering to collect signatures and over 50,000 have signed our petition. With no prospect of a national solution to our health care crisis on the horizon, now is the time for our legislative representatives to seize the moment and enact a comprehensive and affordable health care plan for all residents of Maine.
Lawrence R. Kaplan, MD, MPA