Wellstar, UnitedHealthcare Have Vested Interest In Resolving Dispute Quickly: Expert

Negotiations continue between the Marietta-based hospital system and health insurance giant UHC after the two parties allowed their primary in-network contract to lapse on Sunday. Some 80,000 UHC members lost in-network rates at Wellstar facilities overnight because the parties failed to craft an agreement by the deadline.

"There's a lot of pressure on both sides to eventually come to some agreement," Culler said of payer-provider disputes like these. "It's not like this can go on for six months."

Who's affected?Wellstar facilities are now out-of-network for UnitedHealthcare members with group/employer-sponsored and individual plans. Not all UHC members have lost in-network rates, however, and some patients can apply for continuity-of-care waivers.

UHC members with Medicare Advantage Group Retiree and State Health Benefit Plan UHC Medicare Advantage (for Retirees) still have in-network access, with the parties extending that contract until the end of the year. This only applies to existing Wellstar patients, however.

AARP Medicare Supplemental from UnitedHealthcare plans are not affected at all by the contract negotiations, and those members still have in-network access.

Emergency care will be covered at in-network rates - UHC members have been told to go to the nearest hospital in case of emergencies.

Continuity of care is also available to patients such as pregnant women and cancer patients who are in the middle of treatment.

Additionally, UHC said that most of the medical providers affiliated with the Wellstar Clinical Partners, the system's clinically integrated network, have individual contracts with UHC.

Barbara Corey, Wellstar's senior vice president of managed care, told the MDJ Wednesday that patients ought to consider rescheduling non-urgent appointments for next month to avoid paying the out-of-network rates. Patients should contact UHC to get an estimate on what they might have to pay out of pocket before going to Wellstar facilities, she said.

Wellstar has also suggested that individuals or companies that rely on Wellstar for care and use UHC as their insurer consider other plans in the upcoming open enrollment period, which begins in November.

UHC, for their part, has said patients should consider receiving care from a different Atlanta hospital system.

Many patients may have not felt the consequences yet. State Rep. Erick Allen, D-Symrna, the chair of Cobb's legislative delegation, said he hasn't heard from constituents yet about the matter. Culler posited that since elective procedures are already on the backburner due to the pandemic, patients that don't need immediate care have time to wait out the dispute.

MultiPlanAdding to the confusion for patients is Wellstar's assertion, and UHC's denial, that there is a third option for UHC members to receive care.

Wellstar has told patients that it gave UHC consent to access Wellstar physicians and hospitals through its secondary agreement with MultiPlan. The rates for MultiPlan are cheaper than out-of-network rates but more expensive than in-network rates, Wellstar says.

UHC, however, said there is no such secondary contract, and that elective or non-emergent services from Wellstar (except for continuity of care) will be considered out-of-network.

'It's unfortunate that Wellstar terminated its contract with UnitedHealthcare and is now willfully spreading misinformation in the community that will mislead its patients into thinking they can continue to receive in-network care at its hospitals and with its physicians when instead they would be subjecting them to out-of-network charges," UHC said on its website.

Corey, the Wellstar executive, said that is a choice by UHC.

"Wellstar gave United its expressed consent to access that contract. … United Healthcare then, on October 3 no less, cancelled their agreement with respect to access to Wellstar with MultiPlan," Corey said.

War of the wordsThe conflicting messages around MultiPlan are just one debate in a larger public relations battle the two parties are waging. Caught in the middle are patients.

"Now, all of a sudden you're out of network, and you get a 20% surcharge or something like that … the patients actually get impacted by it," Culler said. "It's not just (the parties) arguing over whether they're (Wellstar) going to get paid, you know, $1,500 or $1,800 for a procedure."

Wellstar has cited data indicating UHC was untrusted by patients and said that UHC is choosing "profits over patients."

"For far too long, UnitedHealthcare has been interfering in the patient/doctor relationship, increasing denials for needed services and failing to reimburse health systems like Wellstar at fair rates," Wellstar says on its website. "Because of the current outdated agreement, UnitedHealthcare members are unable to take full advantage of the whole Wellstar integrated network of care."

UHC says Wellstar's hospitals are the most expensive in metro Atlanta.

"Yet Wellstar refused to move off its demands for an egregious 37% price hike over three years that would have increased health care costs by more than $109 million," UHC said in a statement. "This is not sustainable or affordable for the people and employers we serve."

Corey pointed to disputes UHC has had with other hospital systems over contracts, where similar arguments were employed.

"I can't really speak to what the insurers pay to various hospitals around the city because I'm not privy to that information, but what I would say is that UnitedHealthcare made the exact same statement about Northside a month or so ago … That's kind of UHC's playbook," Corey said.

Media reports from June indicate UHC also called Northside's Atlanta, Cherokee and Forsyth hospitals the most expensive in the metro area.

For Culler, the Emory professor, dueling talking points are meant to serve as cover from public anger while negotiations continue.

"A lot of it is just sort of positioning yourself so that the public isn't mad at you. …. You're just trying to put the best spin possible on your negotiating strategy, and why you haven't agreed to the other side's deal," Culler said.

Working toward resolutionOn Wednesday, Wellstar said negotiations are "currently in United Healthcare's court," meaning that Wellstar had sent them another offer.

"I can tell you that Barbara (Corey) and her team are working incredibly hard, through the weekend, late into the night," Wellstar spokesperson Trish Nicolas said. "Just really working on behalf of our patients to make sure that we can reach an agreement, but we're doing everything we can."

There isn't any indication that the government has gotten involved to hasten negotiations. A spokesperson for Georgia Insurance and Safety Fire Commissioner John King said King's office is aware of the dispute and monitoring it, but doesn't have statutory authority over contract disputes. Representatives for Gov. Brian Kemp didn't respond to inquiries.

Corey said Wellstar's government relations team has briefed officials on the situation so they can respond to constituents' concerns.

Culler said the state, which has regulatory power over nonprofits and insurance companies, could put some pressure on the parties.

"I think both sides have political support, or have people who could actually put pressure on them to negotiate … both sides have political constituents they have to sort of keep happy," Culler said.

Allen said these sorts of contract disputes were becoming all too common.

"As a member of the (state House) Insurance Committee, it is something that I'm looking at - how can we avoid these insurance cliffhangers in the future," Allen said. "I think we've become immune to them, almost. Every year it's one system versus an insurance company. We've got to be able to do better … if someone is paying into insurance, then there should be providers available to service them."

Culler emphasized that companies with group UHC insurance will be pressuring the parties to reach an agreement. Delta Air Lines, for instance, is self-insured, but its insurance is administered by UHC. Losing such a contract (Delta is metro Atlanta's largest employer, per the Metro Atlanta Chamber of Commerce) would damage the company's revenue.

"The last thing you want, especially if you're United, is to lose a big contract … over a few dollars at Wellstar," Culler said.