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Health Insurance

‘Balance billing’ draws legislative scrutiny

A patient scheduled for surgery makes sure that both the hospital and surgeon are in the health plan’s network prior to the operation.

Sen. Renee Unterman

Sen. Renee Unterman

But after the surgery, a surprise bill arrives for hundreds of dollars. It turns out that the anesthesiologist used in the procedure was not in the patient’s insurance network – and the patient had no idea.

Such “balance billing’’ situations often confound and upset consumers receiving medical care – and can lead to tough collections practices.

A state legislative panel hearing Thursday discussed surprise billing for medical care. The subcommittee was chaired by state Sen. Renee Unterman (R-Buford), who said she has heard from many constituents complaining about medical debt, bankruptcies due to medical bills, and credit rating downgrades.

“It’s so hard on the consumer,’’ said Unterman, chair of the Senate Health and Human Services Committee.

Physicians and members of the hospital and insurance industries testified on surprise medical bills, pointing to varying reasons for their use. They agreed, though, that it’s something that can hit consumers hard. full story

Unsuccessful bidders protest state health contract

Three losing bidders have filed a protest over the state’s selection of vendors for a multibillion-dollar Medicaid and PeachCare contract.

Healthcare CostLast month, four companies – Amerigroup, Peach State, WellCare and CareSource — were picked as winners of the contract to serve lower-income adults and children in Georgia.

The contract for the “Care Management Organizations’’ is worth an estimated $4 billion over six years. The launch date for the new contract is July 1.

But unsuccessful bidders Americhoice (a unit of UnitedHealthcare), Humana and AmeriHealth Caritas have appealed that decision by the Department of Administrative Services, which handles contracting in Georgia. full story

Grady jumps into bidding for Southern Regional

Acting just before a looming deadline, Grady Memorial Hospital Corp. has launched a surprise bid to acquire financially ailing Southern Regional Medical Center, Clayton County’s sole hospital.

Southern Regional Medical Center

Southern Regional Medical Center

The Grady proposal, valued at more than $20 million, sets up a bidding war between Grady and Prime Healthcare Foundation for the 331-bed Riverdale hospital and related assets.

California-based Prime signed a letter of intent in July to purchase the hospital, and that agreement was followed by the owner of Southern Regional filing for Chapter 11 reorganization in U.S. Bankruptcy Court.

Grady submitted its bid for Southern Regional on Friday, the last possible day for additional offers to be made. A bankruptcy court Wednesday moved the date of an auction for Southern Regional to next Wednesday, allowing the Grady bid to move forward.

Grady still needs approval of its corporate board in a vote that will take place Tuesday, in order for its bid to go to auction. full story

Kaiser scores another annual top rating in Georgia

Kaiser Permanente is again Georgia’s top-rated health plan in commercial insurance, according to the National Committee for Quality Assurance.

photo.jpgIt’s the 11th straight year that Kaiser, a nonprofit, got NCQA’s No. 1 rating among commercial health plans in the state.

The NCQA rankings use a 1-to-5 scale, with 5 being the highest.

The 2015-2016 ratings also put Kaiser as the leader among Medicare insurers in Georgia – the only one operating in the state to achieve a 5 score. full story

Piedmont, WellStar cutting back on health plan

WellStar Health System and Piedmont Healthcare are dropping key parts of their joint health insurance plan after just two years of operation.

Healthcare CostCiting costs, the two metro Atlanta systems have told medical providers that they’re discontinuing their Medicare Advantage plan for next year. The current 12,000 Medicare beneficiaries will have options to switch to another Advantage plan or to receive care in the traditional program.

The health plan will also end its offering for employees of Piedmont and WellStar at the end of the year. About 35,000 employees and dependents were estimated to be eligible for coverage from the Piedmont WellStar HealthPlans at the launch of the program. They will be served by other health insurers in 2016.

The moves drastically reduce what was seen as a bold, high-visibility venture by the two nonprofit hospital systems to get into the health insurance business. WellStar and Piedmont leaders, at its outset, said the health plan was a new avenue to improve the quality of medical care and lower costs. full story

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