Letter to the editor: Anthem, MaineHealth both to blame for staggering costs

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As a former board member of Share Health Plan, precursor of United Health Care, and the former president and CEO of a suburban Boston hospital, I bring a unique perspective to the conflict between MaineHealth and Anthem insurance (“$136 charge for $2 saline? Anthem , MaineHealth trade blame,” April 17, Page A1). From my perspective, both organizations are to blame and both organizations are cheating patients, providers and the state of Maine.

For 40 years I’ve watched health care organizations routinely inflate the cost of services by 100, 500, even 1,000 percent. Insurance companies generally didn’t complain, as these costs were passed directly on to the consumer as premium increases.

The insurance companies play a different game. Although this is not commonly known, a certain percentage of claims is automatically rejected on the first submission, thereby forcing the patient and/or provider to resubmit through a long review process. In the meantime, upfront premiums paid to the insurers are available for investment. The system is bankrupt and demonic.

For the past 18 months I’ve served on the board of Maine Healthcare Action, a nonprofit organization that tried unsuccessfully to place a resolve on the November 2022 ballot that mandated the Maine Legislature to pass a universal single-payer health plan by 2024. Hundreds of Mainers volunteered to collect signatures, and over 50,000 signed our petition. With no prospect of a national solution to our health care crisis on the horizon, now is the time that our legislative representatives rise to the occasion and pass a comprehensive, affordable health care plan for all Maine residents.

Lawrence R. Kaplan, MD, MPACape Elizabeth

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