NGHS, Anthem fail to reach agreement

Posted 9:43AM on Tuesday 1st October 2019 ( 4 years ago )

Northeast Georgia Health System is no longer available as an in-network care provider with Anthem after the two sides failed to reach a new agreement by Monday night’s deadline.

In a news release, officials with the health system said Anthem’s demands would negatively impact patient care.

“We have offered Anthem a proposal that is fair to both parties, yet they refuse to work with us in a meaningful way,” Steve McNeilly, vice president of managed care, said. 

For its part, Anthem said it is continuing to negotiate with the health system to get it back in network.

“Our long history of partnership with NGHS gives us hope,” Anthem said in a post on its website. “We’re continuing to work hard to come to an agreement that continues to give you access to affordable care – and also makes sure that NGHS is compensated fairly. Our members are our top priority, so we’re hoping to sign a contract soon so you can regain access to in-network care from NGHS.”

Until a new agreement is reached, patients with Anthem won’t be able to use NGHS facilities as an in-network provider. On its website, Anthem said patients will need to use an in-network care to receive in-network benefits. Those who choose to see an out-of-network care provider will be subject to higher costs. 

NGHS facilities currently out of network with Anthem are all Northeast Georgia Medical Center hospitals; all Rehabilitation Institute, Imaging Center and Cancer Center locations; Hospice of NGMC, New Horizons Limestone and Lanier Park; Sleep Disorders Center; Laurelwood; all Urgent Care locations; all locations of The Heart Center of NGMC; and most Northeast Georgia Physicians Group locations. 

NGPG’s family medicine and internal medicine practices in Buford, Cumming, Dacula and Hamilton Mill are not affected by this negotiation and are still in-network.

The health system also stressed that emergency room access is still in-network. “Regardless of the contract status with Anthem, patients experiencing an emergency should always visit the nearest emergency room,” the news release said.

The health system said it will work to minimize financial impact during the disruption of coverage. Patients should call their providers office to discuss costs for office visits or call the Patient Access Office at 770-219-7678 for questions about out-of-pocket costs for a scheduled procedure or test.

© Copyright 2015 All rights reserved. This material may not be published, broadcast, rewritten, or redistributed without permission.