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‘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

Surprise No. 2: Grady drops Southern Regional bid

Just days after launching a surprise effort to buy Southern Regional Medical Center, Grady announced Tuesday that it has called off its bid for the struggling Clayton County hospital.

Southern Regional Medical Center

Southern Regional Medical Center

Grady Health System officials cited a tight time frame, mandated by a bankruptcy court, in their decision to back away from pursuing Southern Regional.

The decision by Grady’s corporate board means, in all likelihood, that the Riverdale hospital and its assets will go to California-based Prime Healthcare Foundation, which has offered $18 million. The bankruptcy court still needs to approve the sale to Prime at a hearing Thursday.

Grady made its bid Sept. 25, just before a deadline, with a proposal that was valued at $20.5 million.

“Grady was not originally invited to participate in the acquisition process before Southern Regional’s bankruptcy filing,’’ said Grady Health System CEO John Haupert in a statement Tuesday. “It was only very late in the process that Grady was made aware of the opportunity to participate.’’ 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

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

Memorial starting partnership talks with N.C. system

A Savannah health system’s announcement that it will pursue a strategic partnership with Novant Health fits into the recent flurry of hospital consolidation across Georgia.

Memorial University Medical Center

Memorial University Medical Center

This potential nonprofit hospital combination is unusual in one way: It involves an out-of-state hospital system. Novant is based in North Carolina. But Savannah’s Memorial Health and Novant have been working together since 2012 with a “shared services agreement” that they say has led to cost savings.

Partnership and acquisition talks have sprung up in metro Atlanta and elsewhere in Georgia as hospitals look for ways to weather the rapid changes in health care, many of which were sparked by the Affordable Care Act.

The board of Memorial Health this week authorized its directors and senior management to work on an “exclusive basis” with Novant Health. Board Chairman Harry Haslam said a goal was to “ensure long-term stability amid the changes in health care reform.” full story

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