Thousands of UnitedHealthcare members are now facing much higher out-of-pocket costs if they go to two Gwinnett County hospitals. The insurer’s contract with Northside... Northside contract rift with insurer affects thousands in Gwinnett

Thousands of UnitedHealthcare members are now facing much higher out-of-pocket costs if they go to two Gwinnett County hospitals.

The insurer’s contract with Northside Hospital Gwinnett (in Lawrenceville) and Northside Hospital Duluth ended March 1.

Contract negotiations between insurers and hospitals sometimes become public and nasty in tone, but usually are settled before a renewal deadline.

Northside Hospital Gwinnett

Both UnitedHealthcare, based in Minnesota, and Atlanta-based Northside say they’re focused on ensuring the affected patients get needed treatment.

“We have close to 11,000 patients who now are out-of-network for care at two Northside hospitals – Gwinnett and Duluth,’’ Lee Echols, a Northside vice president, told GHN in a statement. “Our patient care leadership is doing everything possible to ensure patients receive treatments and have options. But with the worst public health crisis in more than a century still wreaking havoc, the timing of UnitedHealthcare’s move is hard to understand.”

United said Monday that about 5,000 members received care at one of the Gwinnett facilities in the past year and were notified of the network change.

Northside Hospital acquired the former Gwinnett system, including the Lawrenceville and Duluth hospitals, in 2019. Gwinnett is the second most populous county in the state.

United emphasizes that during the dispute, patients have other options for getting hospital care in or near Gwinnett County, including Eastside Medical Center in Snellville and Emory Johns Creek Hospital in Johns Creek. The main Northside campus in Atlanta and its hospitals in Cherokee and Forsyth counties remain in United’s network.

The contract termination does not affect United’s contract with Northside Gwinnett’s employed physicians.

“Despite repeated efforts, we were unable to reach an agreement to renew our relationship with Northside Health System’s Gwinnett hospitals,’’ United said in a statement.

“While we remain committed to continued discussions with Northside to restore network access to its Gwinnett facilities at an affordable cost for the people we serve, our primary focus at this time is ensuring that our members have uninterrupted access to the care they need and supporting them as they transition to new care providers.”

Also out of network now are Northside Gwinnett Joan Glancy, a rehabilitation facility, and Northside Gwinnett Extended Care Center.

Craig Savage, a consultant with North Carolina-based CMBC Advisors, said the COVID-19 pandemic has brought much uncertainty into the health care marketplace.

For managed-care insurers like United, ‘‘quality of services is still important,’’ Savage said. But he added that he believes the prices of hospital services will be the major driver in contracts, “as long as your enrollees have reasonable geographic access [to hospitals and other medical facilities].’’

The nonprofit Northside system said last week that it has added or will add beds at all five of its hospitals.

Northside Hospital Duluth

 

Northside Gwinnett expanded its inpatient capacity in December with 71 fully equipped modular units — being used for inpatient care of all types, and is wrapping up renovation and expansion of two inpatient units for cardiovascular medical and surgical patients. Construction also is under way on an expansion of the Emergency Department, which will double its current size, Northside said.

And in August, Northside Duluth opened 16 modular beds, followed by another six beds in October, and in January 2021 added 10 observation beds adjacent to the ED. In all, the hospital will increase its capacity by more than 40 percent this year.

Here’s a link to a recent AJC article about Northside and the COVID relief money that its hospitals received.

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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