Health insurance case goes to Georgia Supreme Court

Lawyers for Anthem, a large health insurance company, and Northside, an Atlanta hospital system, debated the meaning of “public health emergency” and jurisdiction over legal appeals.

The dispute is rooted in Anthem’s decision to terminate Northside from its insurance network in May 2021. Anthem claims it dropped the Atlanta hospital system because Northside “billed exorbitant sums [to Anthem] over the years” and was “an extreme outlier in costs among Anthem’s contracted providers,” according to a brief filed with the court.

The insurer and hospital tried to negotiate a solution but were unable to come to an agreement.

Northside then filed a lawsuit against Anthem last December just before the planned termination was to take effect. A Fulton County judge issued a temporary injunction forestalling Anthem’s termination of Northside from the Anthem insurance network.

Anthem has now appealed that injunction to the Georgia Supreme Court.

One legal issue centers around the definition of “public health emergency.” That’s because the General Assembly passed a law during the 2021 session prohibiting insurers from dropping health-care providers from their networks during and for 150 days after a “public health emergency.”

Northside contends that the 2021 statutory reform should bar Anthem from dropping the hospital system from its insurance network.

But what, exactly, is a public health emergency under the terms of the new law?

Former Supreme Court Chief Justice Harold Melton — representing Anthem — argued for a narrow definition of a public health emergency, while Northside lawyer Robert Highsmith argued for a broader definition.

The Supreme Court’s jurisdiction for determining constitutionality of the Fulton County trial court’s injunction was another issue Melton and Highsmith debated.

The legal issues may appear arcane to most Georgians. But two justices pointed out that ordinary Georgians are affected by the failure of the two parties to reach an agreement and urged them to come to terms with each other.

“It might be for the benefit of everyone to work this out and moot this case,” noted Justice Nels S.D. Peterson during the arguments.

Tuesday’s appearance was former Georgia Supreme Court Chief Justice Harold Melton’s first in his old courtroom as a lawyer, not a judge. Melton was appointed to the Georgia Supreme Court by then-Governor Sonny Perdue in 2005. Melton stepped down in 2021.

Neither side would comment to the media, though Melton did term his first appearance on the other side of the bench “nerve-wracking.”

Georgians can expect a decision on the dispute within six months.