Northeast Georgia Health System patients with commercial UnitedHealthcare health insurance plans could be forced out of network on May 1 as the two entities struggle to reach an agreement on a new contract.
This comes as the current contract between NGHS and United is set to expire on April 30.
All facilities within Northeast Georgia Health System would be impacted if the two entities fail to come to an agreement by the deadline, including all Northeast Georgia Medical Center hospitals, all Northeast Georgia Physicians Group practices and all urgent care locations. Only patients with UnitedHealthcare commercial, employer-sponsored health plans would be impacted. It would not impact members of UnitedHealthcare Medicare Advantage plans and Health Insurance Exchange plans.
Steve McNeilly, vice president of managed care and chief operating officer of population health at NGHS, said contract negotiations are a normal part of business in the healthcare industry, but United's contract renegotiation is overdue.
"We renegotiate with insurance companies every two to four years, and we have renegotiated all of the other insurance companies' agreements," McNeilly said. "United's is old. It's dated back to 2012. So the language and the rates and their agreement needed to be updated to match those in the market."
Compromises
McNeilly said NGHS and United have met frequently over the past year, yet an agreement has not been reached.
"For the better part of the year, we have been meeting weekly, sometimes more than once a week with United, and trying to move in their direction on as many of these terms and rates as possible, and Northeast Georgia Health System has made compromises and has moved in United's direction," McNeilly said. "Unfortunately, we can't get United to engage in these conversations, and they have not moved in our direction at all."
However, United claimed otherwise. In an emailed statement, a United spokesperson said United will soon be delivering their fourth proposal to NGHS that reportedly includes additional movement.
"We continue to compromise in the spirit of good-faith negotiation," the statement from United said.
But McNeilly disagreed with United's comments, again claiming United has not made any compromises.
"When they say they've given us counter-proposals, it's essentially telling us no to the terms and the rates that we've asked them for, so they haven't really come back with anything new," McNeilly said. "We've been working on this ... for almost a year. About a month ago, they sent us a brand new proposal that completely scrapped the work we've done over the last 12 months. Many of the rates and terms in that last proposal are even worse than what we were dealing with a few months ago."
Price increases
United said its main concern relates to an alleged price increase proposed by NGHS.
"NGHS is demanding a near 25% price hike over the next three years, which would make its hospitals the most expensive in Georgia," United said in an emailed statement. "These demands are not sustainable and would significantly drive up health care costs for the people and employers we serve in northeast Georgia. We ask that NGHS join us at the negotiating table with a realistic proposal that's affordable for customers."
McNeilly said the allegations levied by United regarding a 25% price hike were inaccurate.
"Northeast Georgia Health System is actually asking for a single-digit increase," McNeilly said. "Just like the price of bread, inflationary factors come into play. We're simply trying to bring them in line with the other commercial insurance companies. We're also not asking UnitedHealthcare to do anything in this contract that all of the other commercial insurance companies have not already agreed to."
McNeilly also said United's claim that NGHS' price increase would make its hospitals the most expensive in Georgia was untrue.
"We routinely talk to health systems all over Georgia that have gone through negotiations with United before, and all of these health systems tell us that United tells them the very same thing. We have done market research to prove that we know that is not the case," McNeilly said.
However, United said they refuse to agree with the alleged 25% price increase as they believe higher rates could impact economic growth in the region.
"It would mean [businesses] have less money available to pay competitive wages and to help grow the business through things like investments in new technologies," an emailed statement from United said.
But McNeilly said NGHS has a first-hand understanding of how higher prices can impact business in the area, as NGHS is the largest employer in the community.
"We're right there with other employers, our costs are going up just like everybody else's are," McNeilly said. "We're very conscientious of that, and we're very concerned. I would ask United to take a look internally and see what they could do to lower premiums for employers that are struggling with cost."
Uncertainty
While the negotiations continue to be the key focus for NGHS and UnitedHealthcare, one question remains for community members: will an agreement be reached before the April 30 deadline?
"We don't have a lot of time left," McNeilly said. "There are still many outstanding issues. I have less of a degree of confidence that we'll reach an agreement by April 30. But we're trying every day to move it forward. I would start to prepare the community, there could be some disruption. If we have disruption, and our health system and our physicians go out of network with United, there are resources available to members so that they can understand what their options are."
United said it does intend on finding a proposal that both parties can agree on.
"Our goal is to renew our relationship and ensure the people we serve have continued access to NGHS while also helping ensure health care remains affordable for consumers and employers," United said in an emailed statement.
McNeilly said NGHS patients with commercial United plans have several options when it comes to preparing for disruptions. Specifically, he suggested calling to see if you can reschedule any appointments or procedures scheduled on or after May 1 to an earlier date. Additionally, community members can apply for Continuity of Care by April 1. This program applies to certain patients, including those who are pregnant or undergoing an active course of treatment. A Continuity of Care form can be found at this link.
More information about the negotiations from Northeast Georgia Health System can be found here.
