At 79 years old, Pete Roshau of Gainesville doesn’t want to worry about scrambling for a new health insurance provider.
Because of the stalemate between Anthem and Northeast Georgia Health System, Pete Roshau and his 77-year-old wife, Glinda, must make a difficult decision before their open enrollment ends Dec. 9.
They are insured through the federal government from Pete Roshau's previous job with the Department of Agriculture and have been with Blue Cross and Blue Shield for 30 years. Pete Roshau said they didn’t have any issues with the provider until it became Anthem Blue Cross and Blue Shield in Georgia in January.
“The failure to reach a contract has forced us to face a hospital change, health insurance change and we’ll probably lose some of our doctors,” Pete Roshau said. “The bad thing about it is that the doctors we’ve established a history with, they know us and know what our problems are. It’s going to make it very difficult.”
Anthem and the Northeast Georgia Health System have made no progress on negotiations since NGHS went out-of-network with the insurer on Oct. 1. Both sides say they’re willing to negotiate, but no moves have been made since the contract expired.
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The Times has been following the dispute between the Northeast Georgia Health System and Anthem Blue Cross and Blue Shield, speaking with hospital officials and Anthem representatives since before the hospital went out of network with the insurer Oct. 1. As open enrollment deadlines begin hitting, The Times pursued stories from those in the community who are affected by the stalemate. Meanwhile, reporters followed up with the health system, including a meeting with its key leaders and numerous follow-up conversations about what is happening and why. The Times also dug into lawsuits between the two that pinpoint some of their major disagreements over medical coverage.
Steve McNeilly, vice president of managed care for the health system, said NGHS hopes to come back to the table.
“We stand ready to meet and work with Anthem to get a deal done at any point, but they have had no communication with us for the better part of a month,” McNeilly said.
According to a statement from Anthem, the insurer is also willing to continue negotiations.
“We provided a revised proposal to them two days before the contract expired and did not receive a response,” the statement reads. “Although the contract has now expired, we are willing to resume talks so we can come to a new agreement that is fair, provides flexibility and protects affordability. … What NGHS proposed was simply not sustainable for our members.”
NGHS spokesman Sean Couch said NGHS sent Anthem a proposal on Sept. 29 in which the system had made concessions on “roughly 50 or 60 line items” where the two parties had disagreed on the language. But Anthem’s proposal that day was “not actually an updated proposal,” Couch said.
“They essentially responded back with the exact same language they had been sharing before,” he said.
NGHS is treating Anthem patients as in-network until the end of the year. McNeilly said this costs the health system more than $10 million a month, but in the long run, it’s a better option — the five-year contract NGHS is negotiating with Anthem has a $2 billion value.
Meanwhile patients like Pete and Glinda Roshau require follow-up appointments with their doctors and must make long-term plans.
Pete Roshau is a survivor of prostate cancer, has undergone knee replacement and hip replacement surgeries and has diabetes. Glinda Roshau has kidney problems and relies on a specialist in Gainesville.
Because most of their doctors work through the health system, Glinda Roshau said they may have to start traveling to Northside Hospital in Cumming.
“Maybe if I was a little bit younger, this wouldn’t be a problem, but at our age it’s difficult to go through the hassle of changing everything,” Pete Roshau said.
Open enrollment ends Nov. 8 for state employees, which includes public school system employees along with 3,000 University of North Georgia faculty, staff, retirees and dependents.
Matthew Boedy, professor of English at the University of North Georgia in Gainesville, said many of his co-workers don’t know what to do.
Boedy is the vice president of UNG’s chapter of the American Association of University Professors. He said the local chapter conducted a survey among the faculty and staff to gauge their frustrations with the stalemate.
“Some of the stories shared (anonymously) are concerning and scary for those people,” Boedy said. “... I know many of our faculty and staff are deeply frustrated and still undecided about what to do about the open enrollment process, which ends (Friday). Some are suggesting they would switch to more expensive plans because it is Kaiser, not Anthem.”
David Broad, president of the local UNG chapter of AAUP, said Anthem and the health system’s failure to come to a contract has put his family in a tough position. Their medical professionals of 14 years are no longer in-network and they’re forced to find new doctors.
“Just losing the long-established relationships we have with our doctors is devastating,” Broad said. “I have taught the children of my doctors. They are my neighbors and my friends. I feel the Anthem-NGHS dispute very personally.”
Boedy said he would like to see Gov. Brian Kemp step in like Gov. Nathan Deal did in April 2018, when Piedmont Healthcare and Anthem disagreed over their contract. Deal announced a handshake agreement between the two, who soon after signed a deal.
“I also would like to see the university system push away from Anthem, which runs the benefits system statewide,” Boedy said. “The leverage the university system has is to walk away. ... On the other hand, Anthem doesn't seem to care about the 3,000 employees here at UNG.”
Times reporter Megan Reed contributed to this article.