The contract between Northeast Georgia Health System and UnitedHealthcare expired Monday, forcing patients with commercial United insurance plans out of network.
This follows months of unsuccessful negotiations between the two corporations.
All facilities within Northeast Georgia Health System are impacted, 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 are impacted. It does not impact members of UnitedHealthcare Medicare Advantage plans and Health Insurance Exchange plans.
Patients will always have in-network access to NGHS emergency rooms, regardless of the status of the contract between NGHS and United.
"While we remain committed to working with NGHS to find a solution that’s affordable for consumers, our focus now is ensuring the people we serve have access to the care they need through either continuity of care or a seamless transition to a new provider," a United spokesperson said in an updated statement Monday morning.
"We know how upsetting this is for our patients, and we share their frustration. United’s actions are disruptive, leaving their members with little access to in-network care in north Georgia," Steve McNeilly, vice president of managed care and chief operating officer at NGHS said in a statement.
Both entities encourage patients to apply for continuity of care in the wake of the disruption. This allows select patients to continue receiving care at in-network rates. This primarily applies to those who have a serious acute or chronic condition. Patients who wish to apply should fax or mail a completed CoC form to United. The form is available here.
Original story published Friday, April 28, at 5:00 p.m.:
Northeast Georgia Health System and UnitedHealthcare have not yet reached a new contract agreement, which could force patients with commercial UnitedHealthcare plans out of network once the current contract expires 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 end of the day Sunday, 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.
Patients will always have in-network access to NGHS emergency rooms, regardless of the status of the contract between NGHS and United.
“Unfortunately, we expect UnitedHealthcare to remove all Northeast Georgia Health System locations from its network for patients with commercial health insurance plans on Monday, May 1,” Steve McNeilly, vice president of managed care and chief operating officer at NGHS said in an updated statement. “This will not affect Medicare patients.”
As previously reported, NGHS and United have met frequently over the past year, but an agreement has not been reached.
United claims NGHS has made it difficult to reach an agreement due to a series of alleged meeting cancelations.
"We provided a fair and reasonable proposal on March 31 that included meaningful rate increases," a United spokesperson said in an emailed statement. "Unfortunately, NGHS has refused to respond to our proposal and has canceled all of our meetings over the past few weeks, making it apparent the health system intends to disrupt Georgians’ access to its hospitals and physicians."
However, McNeilly said the March 31 proposal excluded some services and some NGHS locations.
"After analyzing the hundreds of pages of legal language, we responded on April 17 encouraging United leadership to consider our last proposal sent on March 23 because it addressed all the concerns," McNeilly said.
Additionally, McNeilly said the health system has shifted its focus away from negotiation meetings with United.
"In our current agreement with UHC, we are bound to complete negotiations by February 28, 2023, so that if an agreement wasn’t reached, we would have time to help patients prepare for an out-of-network period," McNeilly said. "NGHS continued to negotiate well past that February deadline, but because none of the leaders and decision makers at United were coming to the meetings, we redirected our efforts to preparing to go out-of-network."
McNeilly said patients with commercial UnitedHealthcare plans should take several actions as they prepare for possible disruptions. These include:
-
Apply for Continuity of Care. Certain patients underdoing active treatment may qualify to continue receiving care at in-network rates, regardless of the contract negotiation. Patients who wish to apply should fax or mail a completed CoC form to United. The form is available here.
-
Find out if you have out-of-network benefits. Some United insurance plans offer out-of-network benefits, which allow continued access to NGHS.
-
Find out if you might be covered until October 27. New Georgia legislation provides extended coverage to some patients as if they were in-network until October 27. Find out more here.
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."
Find out more about the contract negotiations by clicking here for Northeast Georgia Health System’s viewpoint, and here for UnitedHealthcare’s viewpoint.
