Fox in the Henhouse?

Anthem's role as the provider of DirigoChoice health insurance

Full report (PDF file)

Executive Summary

In 2003, a majority of both houses of the Maine state legislature passed the nationally heralded Dirigo Health legislation. A key component of the Dirigo Health plan is the DirigoChoice insurance product, which is provided through Anthem Blue Cross and Blue Shield of Maine, the State’s largest for-profit insurer.

As of February 1, 2006, 9,270 Maine people have enrolled in the DirigoChoice insurance plan. However, throughout 2005, members of the Maine People’s Alliance from around the state reported to the organization that they were having difficulties enrolling in the DirigoChoice plan. In the fall of 2005, the Maine People’s Alliance decided to conduct a more systematic study of what was happening when potential enrollees called Anthem to inquire about the DirigoChoice plan.

Between November 10, 2005 and January 28, 2006, 37 volunteers made calls to Anthem producers across the state to request information about the DirigoChoice plan. Based on those calls, the following results were obtained:

• One in three producers (33%) were reported to be “Not enthusiastic at all” when asked about the DirigoChoice plan.
• Less than half of producers (45%) were reported to be “Very accommodating” over the course of the inquiry.
• Forty-percent of the producers called attempted to dissuade callers from enrolling in the DirigoChoice plan.
• More than half of callers (52%) were not informed that they might qualify for discounts on the initial premium and deductible quote they were given.
• Twelve percent of the producers called actually made negative comments about the DirigoChoice plan or its likelihood of succeeding.
• Despite having inquired about the DirigoChoice plan, 1 in 5 callers (20%) were offered a competing plan without necessarily being offered an explanation of differences in coverage or cost.

The results of this study raise real concern that Anthem has failed to represent the DirigoChoice product enthusiastically or accurately—unfortunately, to the detriment of the many thousands of families who might have enrolled had they been treated and informed properly.

Given Anthem’s ultimate financial interest in the direction of healthcare reform in Maine, Mainers would be wise to question their involvement as the provider of DirigoChoice insurance.

The results of this study point to the following questions: Has Anthem allowed their political and financial interests to outweigh their contractual obligation? Does Anthem truly want the DirigoChoice product to succeed? Is Anthem the “Fox in the Henhouse”?

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Maine People’s Alliance—Organizing for a Better Maine!

565 Congress St., Suite 200, Portland, Maine 04101; (207) 797-0967; mpa@mainepeoplesalliance.org
27 State Street, Suite 44, Bangor, Maine 04401; (207) 990-0672; jesse@mainepeoples alliance.org
145 Lisbon Street, Suite 200, Lewiston, Maine 04240; (207) 782-7876; kate@mainepeoplesalliance.org