Gainesville-based system warns of potential break with Anthem Gainesville-based system warns of potential break with Anthem
Northeast Georgia Health System has sent letters to 40,000 patients, warning them that its contract with Anthem Blue Cross and Blue Shield may end... Gainesville-based system warns of potential break with Anthem

Northeast Georgia Health System has sent letters to 40,000 patients, warning them that its contract with Anthem Blue Cross and Blue Shield may end Sept. 30 without a new agreement.

The Gainesville-based system said that Anthem is seeking “drastic cuts’’ in payments for medical services.

Anthem is making decisions on local networks from its Indianapolis headquarters, and Georgia officials with the company “now have little say’’ on key matters, said the May 30 letter, signed by Steve McNeilly, a vice president of the Northeast Georgia system.

Most such disputes between insurers and hospital systems are ultimately resolved, often just before the previous deal expires.  But stalled negotiations can create anxiety for patients, who fear losing coverage for their doctor or preferred hospital.

The contract difficulties come at a rocky time for Anthem Blue Cross, which is by far Georgia’s biggest health insurer.

Industry sources say that Jeff Fusile, president of the Georgia plan, is resigning later this month. An Anthem spokeswoman did not respond to GHN queries on Fusile’s status. He has been in charge of the Georgia plan’s operations since 2015.

Fusile

Anthem Blue Cross will be the subject of a Georgia department of insurance hearing this month about the adequacy of its network in an exchange health plan.

During Open Enrollment for 2019 insurance plans in the state exchange, the online information for consumers late last year showed WellStar hospitals and doctors as part of Anthem’s Pathway health plan. But enrollees say they didn’t realize during the sign-up period that the Anthem-WellStar contract for that plan was scheduled to end in February.

That contract termination – and the uproar over patients having to switch doctors and hospitals — led to litigation against Anthem, which has declined to comment on that lawsuit.

Anthem has said that it “has done nothing that is misleading, unfair or deceptive’’ in relation to the WellStar conflict. “Anthem will be present at the hearing and present information that makes clear that Anthem has done nothing that is misleading, unfair or deceptive,’’ a spokeswoman, Christina Gaines, said in May.

And when the state recently released consumer complaint data for all insurers in 2018, Anthem Blue Cross and Blue Shield was among companies with high levels of these patient problems.

Northeast Georgia said “the health plan we are negotiating with is not the Blue Cross of Georgia we have collaborated with for more than a decade, and it is clear that local representatives now have little say. All true decisions seem to be made by Anthem’s corporate headquarters in Indianapolis, far from the people who are impacted by those decisions.’’

Northeast Georgia’s letter to patients is unusual in its four-month lead time before the contract ends, said Craig Savage of CMBC Advisors, a North Carolina-based consultant.

“Maybe they’re thinking, ‘We don’t know what’s going to happen,’ ‘’ Savage said.

Northeast Georgia Medical Center

 

Northeast Georgia cited recent media coverage of Anthem’s negotiations across the nation, including some with hospitals in Atlanta. “We simply don’t want our patients to be caught unaware,’’ McNeilly told GHN.

“Patients shouldn’t make any changes now – and they should continue to use [Northeast Georgia] facilities and physicians.’’

Both hospital systems and health insurers have been consolidating in recent years to gain more clout in contract negotiations. Northeast Georgia itself is expanding, with an agreement to invest $15 million in Habersham Medical Center with hopes of buying the hospital after five years. And it plans to open a scaled-down hospital in July on the site of a closed facility in Dahlonega.

Savage, the consultant, said Anthem appears to be consolidating its operations in Indianapolis to achieve economies of scale.  The question is whether they’re getting good information back at the state and local levels, Savage added.

“My guess is insurers are feeling pressure about large [hospital] systems consolidating.”’

Gaines, the Anthem spokeswoman, said Tuesday that helping ensure consumers ‘’have access to health plans that offer greater affordability and access to quality health care remains our focus at Anthem Blue Cross and Blue Shield.’’

“Northeast Georgia Health System is currently in our provider network, so it is important to note there is no immediate change to health care coverage for any of our consumers. Our local negotiating team has been engaged with Northeast Georgia for several months as we work toward a new agreement that would retain Northeast Georgia in our network beyond September 30.”

Northeast Georgia said that it has received a few phone calls from patients who received the letter. “And while some patients have been concerned about the negotiation, many have been supportive of Northeast Georgia Health System.  Some have had questions about their insurance coverage, and we’re reassuring them that for now nothing changes – there is still time to reach an agreement.’’

It’s bound to be a tense negotiation period for patients. Such disputes are “a game of chicken, and at the end of the day somebody blinks and they come to an agreement,” said Wendell Potter, a former senior executive at health insurance giant Cigna, according to a Kaiser Health News article. “The big losers in this are patients, because there’s a period of uncertainty and angst and a real possibility that the physicians and hospitals you want to go to are no longer in-network.”

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

  • Joy

    June 5, 2019 #2 Author

    I hope the State of Georgia Employee Benefits is shopping health insurance instead of continuing with Anthem. They are a monopoly in Georgia.

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