Anthem Talks Stuck in Neutral

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Update: Anthem and Northeast Georgia Health System have reached an agreement for continued in network coverage.

BY ERIC PEREIRA

As December nears, there is still no clear sign of Anthem and Northeast Georgia Health System reaching a new contract agreement.

NGHS was removed from Anthem’s network Oct. 1 after both parties could not come to a new agreement for their new contract. NGHS is still continuing to treat Anthem patients as in-network through Dec. 31, which Vice President of Managed Care Steve McNeilly said would cost millions per month.

“Unfortunately, Anthem continues to mislead the community by stating that our contract negotiations are only about payment rates. The reality is that it is about more than rates,” McNeilly said.

Here are a few of the terms he said Anthem is requesting:

• The ability to change NGHS’s contract at any time, “including eliminating access to medical services, refusing payment for emergency room visits or changing the rules – even in the middle of a contract year,” McNeilly said. “This means that patients may receive a medical service from NGHS without issue one day, and the next time they need that service, it won’t be covered. For example, Anthem recently refused to cover a patient’s visit to our emergency department following a gunshot wound to her hand;”

• Requiring that NGHS conduct a financial assessment before providing any emergency medical treatment. In other words, emergency care would only be provided until after the patient’s consent to pay is confirmed according to McNeilly.

• Making decisions over physicians. “For example, a Northeast Georgia Physicians Group patient was directed by Anthem to an imaging provider other than The Imaging Center of Northeast Georgia Medical Center, resulting in a two-week delay of diagnosis and treatment of that patient’s brain tumor,” McNeilly said.

Anthem declined to comment on any specific details of negotiations. However, they did say in an Oct. 11 edition of The Northeast Georgian that NGHS’s latest proposals were projected to increase costs well above other health systems in the state.

“While we cannot comment on specific details of the negotiations, it is important to note that the contract terms being negotiated with NGHS are consistent with our other provider agreements and reflect a shared commitment to provide access to quality, affordable healthcare,” said Christina Gaines, communications director for Anthem. “While we still have work to do, Anthem has made numerous compromises thus far in an effort to reach an agreement. But we will continue to stand firm in our commitment to work toward a contract that protects affordability and sustainability for employers and consumers.”

McNeilly said NGHS has also made concessions to agree to some of Anthem’s terms.

Several Northeast Georgia residents in an Oct. 18 Facebook post for Voice of Habersham and Northeast Georgia commented that they are either switching to other hospitals like Piedmont Athens Regional or are considering or have switched their health insurance provider.

“While NGHS has publicly stated it will bill Anthem members as in-network for treatment, we cannot guarantee they will not balance bill for the difference between an allowed amount for a claim and the full billed charges from an out-of-network provider,” Gaines said.

Anthem said they remain steadfast in their goal to include Northeast Georgia Health System.

Tom Hensley, president of Fieldale Farms Corp. said he has arranged a meeting with executives from both parties to continue discussions next week.

“We’ve had no issues whatsoever,” he said in regard to any Fieldale employee patient difficulties and he said the company plans to keep using Anthem as they have for decades.

“Leaders from both sides recently sat down to talk,” Gaines said. “It is our hope they will re-engage with negotiations so we can get back to putting the focus where it belongs – the consumer.”