The latest on contract dispute between Northeast Georgia Health System and UnitedHealthcare [The Times, Gainesville, Ga.]

May 16—With the care of more than 12,000 area policyholders at stake, a stalemate has been reached in talks over a new contract between UnitedHealthcare and Northeast Georgia Health System.

Both sides had heated responses when asked whether talks were ongoing.

"We provided a fair and reasonable proposal on March 31 that included meaningful rate increases," UHC said in a statement Monday, May 15. "Unfortunately, NGHS refused to respond to our proposal, canceled all of our meetings over the past few weeks and chose to disrupt Georgians' access to its hospitals and physicians."

According to NGHS, "The last communication we had about the contract with United was on April 17 when we reached out to their senior leadership in Georgia to encourage them to accept our latest proposal. Unfortunately, United did not respond, and they have not been in touch with us since then."

A contract between the two sides expired April 30, without an extension agreement.

NGHS has noted on its website that United had "removed all NGHS locations from its network for patients with commercial health insurance plans.

The negotiations only affect those on employer-sponsored or individual health plans. Those on Medicare or through the Veteran Affairs Community Care Network are not affected.

The war of words has been ongoing.

"NGHS refused to move off its demands for a more than 20% price hike over the next three years, including a double-digit rate increase in the first year that would make its hospitals the most expensive in Georgia," UHC said in a statement earlier this month.

The hospital system said on May 1 it "is actually only asking for a single-digit increase to bring UnitedHealthcare in line with other commercial insurance companies" and "the proposal they sent on March 31 is unreasonable. They know we cannot accept it."

Those who were approved for continuing care before the contract deadline — such as pregnant patients and people undergoing cancer treatments — can receive care at in-network rates.

Also, NGHS also says on its website that "new legislation in Georgia provides extended coverage to some patients as if they were in-network until Oct. 27."

The state passed legislation in 2021 that requires an insurer to reimburse a provider at in-network rates for 180 days, or through the last day of a covered person's coverage, whichever comes sooner, if the provider is listed as a participating provider in the insurer's provider directory during open enrollment, according to the state Office of the Commissioner of Insurance and Safety Fire.

NGHS and Anthem were engaged in a similar battle in 2019.

Negotiations dragged past a Sept. 30 deadline that year, with the two parties finally reaching an agreement in January 2020.

In that case, NGHS had agreed to honor in-network rates for Anthem patients past the deadline until Dec. 31, saying it was taking a loss of about $10 million per month. When an agreement had not been reached by Jan. 1, Anthem patients became out-of-network with most NGHS facilities.

NGHS isn't pursuing that action with UHC because "in recent years, the federal and state governments have passed consumer protection laws that require insurers to pay for continuity of care when a contract like this expires," said Steve McNeilly, vice president of managed care operations. "We are encouraging our patients to exercise their benefits under these laws."

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