More than 30,000 patients in Maine are facing potential disruptions to their healthcare coverage as a critical contract deadline between Northern Light Health and insurer Anthem Blue Cross Blue Shield approaches. The two organizations must reach a new agreement by the end of Tuesday, September 30, 2025, to avoid significant changes for Anthem members who use Northern Light services.
If a deal is not finalized, many of Northern Light's physicians and non-hospital facilities will be considered out-of-network for thousands of patients starting Wednesday, October 1. This change could lead to substantially higher out-of-pocket costs for medical care.
Key Takeaways
- A contract between Northern Light Health and Anthem is set to expire at the end of Tuesday, September 30.
- Over 30,000 patients with Anthem insurance could be impacted if no agreement is reached.
- Starting October 1, Northern Light physicians and non-hospital services would become out-of-network for many Anthem plans.
- Northern Light hospitals will remain in-network until December 31, 2025, but will also become out-of-network if no deal is made.
- Both parties are currently in mediation but have publicly disagreed on the state of negotiations.
Immediate Impact on Patients
The most immediate consequence of a failed negotiation will occur on October 1. On this date, Northern Light's network of physicians, specialists, and non-hospital facilities will transition to out-of-network status for Anthem's employer-sponsored and individual health plans. Patients using these services will likely face higher costs, such as increased deductibles and coinsurance, as their insurance will cover a smaller portion of the bill.
This change affects routine doctor visits, specialist consultations, and other services provided outside of a hospital setting. Patients will need to verify their coverage directly with Anthem to understand the financial implications of continuing care with their current Northern Light providers.
Understanding In-Network vs. Out-of-Network
"In-network" refers to providers and facilities that have a contract with an insurance company to provide services at pre-negotiated rates. "Out-of-network" means there is no contract, and patients are responsible for a larger share, or sometimes all, of the cost of care. These expenses often do not count toward a patient's annual out-of-pocket maximum.
A Phased Approach to Coverage Changes
The potential loss of coverage is structured in two phases. While physician services are affected immediately in October, hospital services will be handled differently. According to statements from both organizations, Northern Light Health hospitals will remain in-network for all Anthem members through December 31, 2025.
This means that emergency room visits, surgeries, and other hospital-based care will continue to be covered at in-network rates for the remainder of the year. However, if an agreement is not reached by year-end, these hospital services will also become out-of-network.
Impact on Medicare Advantage Members
Patients enrolled in Anthem's Medicare Advantage plans will also be affected, but on a delayed timeline. All Northern Light hospitals, facilities, and care providers will remain in-network for Anthem Medicare Advantage members until December 31, 2025. After this date, these providers would exit Anthem's Medicare network entirely, forcing seniors to find new in-network healthcare options or pay significantly more for care.
Timeline of Potential Changes
- October 1, 2025: Northern Light doctors and non-hospital services move out-of-network for commercial and individual plans.
- December 31, 2025: Deadline for hospital services and Medicare Advantage plans.
- January 1, 2026: All Northern Light services, including hospitals, would be out-of-network for all Anthem members if no deal is reached.
Conflicting Accounts from Both Sides
The negotiations have been marked by public disagreements. Earlier in September, Anthem stated that Northern Light had walked away from the bargaining table for the second time in two months. Northern Light quickly refuted this claim, calling it an “egregious misrepresentation” of the discussions.
Northern Light insists that it has not abandoned negotiations and remains committed to the process. Both parties confirmed they were participating in scheduled mediation sessions on Tuesday in a last-ditch effort to find a resolution.
Anthem proposed an extension of the current contract to avoid immediate disruption for its members while talks continue. However, Northern Light rejected this offer. Suzanne Spruce, Chief Communications Officer for Northern Light, explained the health system's position.
“Anthem has not given us any reason to believe that an extension of the contract at this time would be in the interest of our patients or Northern Light Health.”
Official Statements Detail Sticking Points
In a formal statement, Anthem reiterated its commitment to reaching an agreement and expressed disappointment with the lack of progress. The insurer emphasized the need to protect affordable access to care for Maine residents.
“Our members – their patients – are counting on both of us to reach an agreement soon on a new contract,” Anthem’s statement read. The company also confirmed the timeline of service changes if Northern Light did not agree to an extension.
Northern Light Health's response criticized Anthem for causing “anxiety around healthcare services in Maine.” The provider stressed its continued presence at the mediation table and placed the responsibility for any negative impact on Anthem's members squarely on the insurer.
As the deadline passes, thousands of Maine residents are left waiting to see if they will need to change doctors or pay more for the healthcare they depend on. The outcome of these final hours of negotiation will have a direct financial and logistical impact on families across the state.
