Tuesday April 23rd, 2024 10:35AM

NGHS, Anthem far apart on new deal

Northeast Georgia Health System has negotiated in good faith with Anthem Blue Cross Blue Shield, but the insurance company has refused to compromise on large parts of a proposed new contract, a hospital executive said Friday morning.

Steve McNeilly, vice president of managed care, said the health system’s latest offer has been rejected by Anthem, even though other insurance companies such as Aetna, United Healthcare and Humana have agreed to it.

“When we spent 12 hours a few weeks ago with the CEO of Anthem in our conference room, they said no to 90 percent of the contract,” McNeilly said. “Their response was ‘Anthem can’t agree to that.’ We’re going to need to see some movement if we’re going to get a deal done.”

McNeilly’s comments came Friday morning during an appearance on WDUN’s “Morning Talk with Martha Zoller.”

McNeilly said the hospital’s last counteroffer to Anthem included a single-digit rate increase, but since Sunday afternoon – roughly 36 hours before the contract expired – the health system has had no contact with Anthem.

While McNeilly conceded that costs are a component of the negotiations, he said other demands from Anthem are slowing the process. As an example, he used the hypothetical situation that Anthem could decide not to pay for imaging at a hospital facility and instead require patients to use a stand-alone imaging company to save money.

“That has Anthem playing the role of your physician for cost benefit alone,” he said. “It’s an erosion of your benefits and a move away from the direction of your physician.”

McNeilly said an independent market assessment showed that the health system was reimbursed at about 4-8 percent below peer hospitals in Atlanta.

McNeilly said the hospital will work with patients who have on-going health issues and schedule procedures to help ease their financial burden. But he also suggested that patients look at their insurance options during open enrollment.

“If this doesn’t resolve itself in the next 30 days,” he said, “they should consider a move away from Anthem.”

He said teachers in the area have the option to switch to United Healthcare, which he said has a long-term agreement in place with the health system and its providers.

“We’re at the table ready to talk to Anthem, but they need to move in our direction,” he said. “In our last counterproposal, Northeast Georgia Health System has done all the moving.”

  • Associated Categories: Homepage, Local/State News
  • Associated Tags: insurance, Northeast Georgia Health System, medical, Steve McNeilly, Anthem Blue Cross Blue Shield
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