By Andy Miller and Ariel Hart
A Fulton County judge Friday extended a reprieve in the contract dispute between Northside Hospital and Anthem until April 15, delaying for a second time the need for thousands of patients to switch doctors.
Northside patients who have Anthem insurance have been caught in the middle of the battle between the insurer and hospital system for months. They were facing the risk that their in-network insurance coverage for Northside hospitals and doctors would end at midnight Monday.
The decision by Judge Rachelle Carnesale extends the temporary restraining order put in place earlier this month and includes a provision that Anthem and Northside have a “judicially hosted” settlement conference by Feb. 25.
The stakes remain high for many of the estimated 400,000 people in metro Atlanta with Anthem Blue Cross and Blue Shield insurance who have recently visited a Northside doctor, hospital or clinic. That’s especially true for women who are pregnant and people with serious ongoing medical conditions.
Cancer patient Arlene Sinanian of Buckhead has felt the impact deeply.
Last spring she was diagnosed with a highly aggressive stage 4 breast cancer that had metastasized into her bones. She’s been receiving nonstop care ever since — surgeries, diagnoses, chemotherapy, treatments for ripple effect conditions — from Northside and doctors in its system.
Shortly after she renewed her Anthem policy last fall, she learned of the looming contract dispute. At that time the deadline for the contract termination was Dec. 31. She was told Anthem would give her a “continuity of care” exemption allowing her to stay with her caregivers at Northside if the contract lapsed. She filled out the form.
But approval didn’t happen right away, and her doctors started telling her they couldn’t schedule her. Sinanian began regular phone calls to Anthem representatives. She reports being transferred, disconnected, given incorrect information, finally told she’d be helped, then told that wasn’t true.
As the contract termination deadline approached, she was at wits’ end. “Here it’s Friday, I’m supposed to be going to chemotherapy [Monday] and I don’t think I can afford it. I know I can’t afford it. I would have to sell my house and use up every savings I had.”
On a Friday, the last possible day, Anthem told her the continuity of care request had been approved. Her doctors gave her the scheduled chemotherapy the following Monday.
But the nightmare wasn’t over. Anthem assigned her a new primary care doctor an hour away who would have to learn about her and her treatment regimen.
“The stress level was unbelievable for me,” Sinanian said.
In past years, such insurer vs. hospital system conflicts over reimbursement rates typically would be resolved before termination of a deal. But recently more contracts have lapsed, sending anxious patients into limbo on whether to stay with a medical provider but face higher costs.
Wellstar Health System, based in Marietta, has been out of network for UnitedHealthcare members since early October. That has affected about 80,000 patients, Wellstar said Friday. All of Cobb County’s hospitals are Wellstar facilities.
Health care experts reviewing the Northside/Anthem situation say the two sides need each other – and will eventually work out a deal.
Anthem is the metro Atlanta market’s heavyweight health insurer, while Northside’s system includes an Atlanta hospital that its leaders say delivers more babies than any other community hospital in the nation – more than 15,000 a year. Not having Northside in its network would leave a huge hole in Anthem’s local network.
It’s unusual, though, that a contract dispute is playing out in the courts. At the heart of the legal case is a recently approved state law that went into effect in July.
House Bill 454 includes a provision saying that during a public health emergency, an insurer is prohibited from ending such a contract with a medical provider.
Anthem contends that law is unconstitutional.
Cherokee County recently intervened as an added plaintiff backing Northside’s position. Cherokee, in the northern suburbs of Atlanta, noted that Northside operates the only hospital in the county.
Gwinnett County, the second most populous in the state, has filed a similar motion.
Josh Berlin, an Atlanta health care consultant, said there is increasing frustration for Anthem patients as they try to sort through the tangle of legal and contract issues.
“It’s hard enough to understand health care’s complexity today, but add to that the influx of Anthem-insured Covid patients at Northside, and it just further complicates things.”
Northside said in a statement Friday night that it “is acutely aware of the stress and frustration of Anthem members and their families.’’ The statement said Northside is seeking to reach a deal that “provides the best benefits to patients and their families.”
Anthem said in a statement Saturday that “we have given Northside a fair and reasonable proposal with generous increases.”
“It’s important we work together to finalize a new agreement that works to increase accessibility by protecting affordability and ensuring quality.”
Sinanian has begun a Facebook group for other patients caught in the dispute. It has about 100 members now, she said.
She worries that the dispute and the resulting uncertainty brought on stress that could have set back her recovery — a possibility that her doctors warned her about.
Patients like her, trapped in the contract dispute, are “basically powerless,” she said.
Ariel Hart is a health care reporter for the Atlanta Journal-Constitution.