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Anthem, NGHS reach agreement getting local hospitals back in network
Anthem Marketplace plans are still not in-network at NGHS
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The Northeast Georgia Medical Center's emergency room. - photo by Scott Rogers

The Northeast Georgia Health System and Anthem have reached an agreement that will keep the health system in network with Anthem commercial health plan members. The two parties had been negotiating for almost a year, and their five-year contract expired Sept. 30.

Anthem Marketplace plans are still out of network, according to NGHS. The Marketplace plans were unaffected by negotiations and had already been out of network, NGHS spokeswoman Beth Downs said. Out-of-state Blue Cross and Blue Shield plans are in-network with NGHS because they are commercial plans.

The contract is “multi-year,” but Downs said the exact length of the contract cannot be disclosed.

The health system has updated its website with information for patients who are now back in network. 

NGHS had agreed to honor in-network rates for Anthem patients through Dec. 31, taking a loss of about $10 million a month. When an agreement had not been reached by Jan. 1, Anthem patients became out-of-network with most NGHS facilities. The new contract was signed Jan. 6.

A judge had issued an injunction to keep the system’s Gainesville and Braselton hospitals, as well as Hospice of Northeast Georgia Medical Center, as Anthem locations through Feb. 7. Northeast Georgia Physicians Group’s family medicine and internal medicine practices in Buford, Cumming, Dacula and Hamilton Mill were unaffected by negotiations and would have remained in-network with Anthem even if an agreement was not reached.

“I’m pleased to announce a new multi-year agreement that restores in-network access for patients at all NGHS locations — including all Northeast Georgia Medical Center hospitals, Northeast Georgia Physicians Group offices, The Heart Center of NGMC practices, Urgent Care centers and more,” said Steve McNeilly, vice president of managed care at NGHS, said in a statement. “Negotiations are complex and we recognize that they are often frustrating to members. We appreciate the support and patience of our community.”

The stalemate left thousands of people in Northeast Georgia unsure about how to make health care decisions. 

“Both parties had to make compromises, but in the end, a mutually agreeable contract was achieved,” McNeilly said in an email Tuesday. “This new contract has similar rates and terms to the contracts we have with other commercial insurers.  We also achieved our goal of preserving patient access to care at all NGHS locations.”

The insurer formerly known as Blue Cross and Blue Shield was renamed Anthem Blue Cross and Blue Shield in Georgia in January. Negotiations to renew a five-year contract between Anthem and NGHS began Jan. 30, 2019, but for months the health system and the insurer disagreed on key points of the contract, including rates paid by Anthem and whether NGHS would have to renegotiate with Anthem when it opened or acquired a new facility.

“We are happy to resume our partnership with NGHS in a new agreement that will drive quality, affordability and accessibility for those we serve,” Pam Stahl, president of Anthem Blue Cross and Blue Shield’s Georgia plan, said in a statement. “We value the relationships we have with the providers in our network, which are absolutely critical to creating options for our consumers and fulfilling our mission of improving the lives of the people in the communities we serve.”

Details of the contract are not public.

“We’re both bound by the contract to maintain confidentiality of the details of the contract. Disclosing confidential terms could impact future negotiations with other health systems or insurers,” McNeilly said. “NGHS and Anthem have a longstanding relationship, and we are happy to resume working together to reestablish in-network access for the patients we serve.

A public hearing with Anthem, NGHS and state legislators scheduled for Dec. 30 was canceled on Dec. 28 as the two parties approached an agreement.

“At this time, the parties are down to finalizing language pertaining to a handful of items. Both parties are working diligently and intently on finalizing an agreement,” NGHS and Anthem said in a statement.

State Sen. Butch Miller, R-Gainesville, and State Rep. Terry England, R-Auburn, had planned to participate in the hearing and praised the agreement.

“We are thankful to NGHS’ local healthcare leadership and their team as well as Anthem leadership and their team,” Miller and England said in a statement. “Both NGHS and Anthem worked around-the-clock to keep people informed and reach an agreement that protects the community’s access to high-quality healthcare without leaving this area.”