Anthem agreed to pay $100,000 in penalties, improve its claim-handling procedures and acknowledged that it violated the law in ways that made it subject to disciplinary action.

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Representatives for Anthem and Elevance were not immediately available to comment on the consent agreement.

Anthem Health Plans of Maine: In 2022, Anthem covered 53% of the 295,000 Maine residents who had fully insured individual, small-group or large-group commercial health coverage, according to an examination report posted along with the consent agreement.

The examination: In 2019, analysts at Milliman, an actuarial consulting firm, found that Maine ranked last in terms of the ratio of the number of patients who went to out-of-network providers for behavioral health care to the number who went out-of-network for other types of health care.

The Maine Bureau of Insurance hired outside examiners to analyze how Anthem was handling behavioral health claims.

Maine's examiners looked at claims Anthem processed in Maine from Oct. 1, 2019, through Sept. 30, 2021.

In some categories, the examiners found no problems at Anthem that amounted to violations of Maine insurance laws, according to a copy of the examination report posted by Maine insurance regulators.

Anthem's overall management strategy and provider contracting and reimbursement strategy were in line with state standards.

In most other categories assessed, problems were rare.

When the examiners looked at whether Anthem had provided a summary of benefits and an explanation of coverage in connection with 109 paid behavioral health care claims, only one of the claim files was missing the necessary documents.

When the examiners looked at how quickly Anthem paid claims, it found that Anthem took longer than 30 days to pay clean claims for two of the 109 paid mental health claims reviewed, two of the 109 paid autism claims reviewed and three of the 109 paid emergency room claims reviewed.

But, when the examiners looked at whether the deductibles and other patient cost-sharing bills for behavioral health care were comparable to the cost-sharing bills for other types of health care, they found a big gap.

The examiners found problems in 2,240 of the 4,580 behavioral care claim files reviewed.

In some cases, officials said, patients ended up owing cost-sharing payments when, according to health plan provisions, the patients should not have owed anything.

In other cases, officials said, the cost-sharing amounts for behavioral health care were higher than what the amounts would have been if the patients had received other types of covered care.