“Unfortunately, UnitedHealthcare has allowed the current contract negotiations to fail, preventing thousands of patients in Georgia from accessing networked primary care and services from Wellstar hospitals and physicians,” a Wellstar spokesperson told Becker. “We are discouraged by this development. Our top priority is the health and well-being of our patients, and we continue to strive for a fair agreement from UnitedHealthcare that allows patients to have privileged access to the local Wellstar physicians, hospitals and services they know and trust. As negotiations continue, Wellstar has allowed UnitedHealthcare to offer members the provider`s reimbursement rates associated with the MultiPlan deal if they wish, a Wellstar spokesperson told Becker`s. However, a UnitedHealth spokesperson denied that there is a secondary contract through MultiPlan, meaning patients who receive non-urgent services without prior approval face costs outside the network. Negotiations on the entire contract will continue, Wellstar announced Monday night. “We continue to hope that we can quickly reach a new agreement that prioritizes patient care,” the Marietta-based organization said. The contract between the two organizations ended on Sunday without a new agreement. An estimated 80,000 United members will be affected. Cole Manbeck, a spokesman for UnitedHealthcare, said healthcare affordability is paramount for consumers and employers.
They expect the insurer to help contain costs, which requires maintaining fair and competitive agreements with hospitals and doctors in its network, he said. . Tom Me, CEO of North Country Healthcare in New Hampshire, said outstanding receivables owed to its system increased by $250,000 to $1 million in one quarter. . Wellstar dominates the area of Cobb County where Azzopardi and her husband live. She asked UnitedHealthcare for a “continuity of care” waiver, which would expand its previous coverage in the network for the treatment of an ongoing condition for hospital visits and surgery in October. If that doesn`t work, she could owe thousands of dollars. “I don`t know where he stands,” Azzopardi said. The Atlanta market is facing another such disruption. Anthem has warned consumers that Northside Hospital and its facilities may not be part of its network on Jan. 1.
While the Wellstar vs UnitedHealthcare tug-of-war affects about 80,000 consumers, the Northside contract could affect four or five times as many, according to Northside officials. Contract cancellations hurt hospitals more than insurers, said Nathan Kaufman of Kaufman Strategic Advisors. For example, UnitedHealthcare and Anthem, which operate in multiple states, can “suffer a blow in one state,” he said, because they are diversified and insurers still receive premium payments for members after a contract with a hospital expires. “Both sides said the other was just looking for money,” Azzopardi said. The impasse, she said, “is cruel to patients who have done nothing wrong.” Indianapolis-based Anthem said the contract is cracking and the issue of claims is not related. IT and UnitedHealthcare noted that the vast majority of contracts are renewed without public attention. Payment for medical services is the sticking point. United says Wellstar`s claims for higher reimbursements are exaggerated, and the Wellstar with 11 hospitals says it is targeting the same rates that other insurers pay. In recent years, the vast majority of contract negotiations between hospital systems and insurers have been resolved before a contract is terminated. But recent battles have passed the deadlines to reach a new agreement. But Anthem spokeswoman Christina Gaines said the company is struggling to cut health care costs and Northside is one of Georgia`s most expensive systems. Insurers also point out that health systems have strengthened their bargaining power by acquiring additional hospitals and doctors` offices.
The tough negotiations also extend to contracts with medical groups, said Dave Smith of health consultancy Kearny Street Management. Insurers, he said, “are trying to cut health care costs, and are doing it on the backs of doctors and hospitals.” KHN also recently reported that Anthem Blue Cross is lagging behind with billions of dollars in payments due to hospitals and doctors due to expensive new reimbursement rules, computer issues and mismanaged claims, according to hospital officials in several states. . The open enrollment dilemma is leading Emilie Cousineau of Smyrna, Georgia, to question whether she should stay with UnitedHealthcare or switch to Anthem, which would cost her more in her employer-sponsored plan for the next year of benefits. Azzopardi has UnitedHealthcare coverage, and as of Oct. 3, Wellstar Health System was no longer on the giant insurer`s network after the two parties failed to agree on a new contract. This story was also broadcast on Fortune. It can be republished for free. Nearly 80,000 Georgia residents are affected by UnitedHealthcare and Wellstar`s failure to renew their network contract, which expired on Oct. 3. Tens of thousands of UnitedHealthcare members now face higher expenses when visiting hospitals and doctors in the Wellstar Health System.
Cousineau recently cancelled a Wellstar Well Check appointment because he was suddenly no longer on the network. “Right now, it`s a disadvantage.” But his doctor and his children`s pediatrician are both Wellstar doctors. “I`m picky about my health care,” she said. When Shelly Azzopardi went to Wellstar Kennestone Hospital in September with abdominal pain, she wasn`t worried about her insurance. . Andy Miller, a former AJC reporter, is editor of Georgia Health News. A UnitedHealthcare spokesperson said Wellstar issued a notice of termination in the spring of 2021 with a first-year price increase that would make the provider 40 percent more expensive than other hospitals in the area. .
