By allowing ads to appear on this site, you support the local businesses who, in turn, support great journalism.
NGHS, Anthem insurance negotiations dragging out
Hospital says patients could be pushed out-of-network without a deal

The Northeast Georgia Health System’s contract with insurance provider Anthem, previously known as Blue Cross Blue Shield of Georgia, is set to expire on Sept. 30. NGHS and the insurance company are still negotiating the agreement.

Patients covered by Anthem would be out-of-network at most NGHS facilities beginning Sept. 30 if an agreement cannot be reached. The Northeast Georgia Physicians Group’s family medicine and internal medicine practices in Buford, Cumming, Dacula and Hamilton Mill would not be affected regardless of the outcome.

While heated, drawn-out negotiations between insurers and health care providers are routine and occasionally spill into the public.

All true decisions seem to be made by Anthem’s corporate headquarters in Indianapolis, far from the people who are impacted by those decisions.
Steve McNeilly, vice president of managed care, NGHS

Steve McNeilly
NGHS patients with Anthem have been notified with a May 30 letter making them aware of the situation. The letter from Steve McNeilly, vice president of managed care for NGHS, states that NGHS officials “remain confident there is time to reach an agreement that is in the best interest of all who are impacted, but getting there will be difficult.”

Blue Cross Blue Shield officially became Anthem on Jan. 1. NGHS’ negotiations also began in January, and McNeilly said the health system noticed a negative change in its interactions with Anthem.

“The health plan we are negotiating with is not the Blue Cross of Georgia we have collaborated with for more than a decade, and it is clear that local representatives now have little say,” McNeilly said in the letter. “All true decisions seem to be made by Anthem’s corporate headquarters in Indianapolis, far from the people who are impacted by those decisions.”

The negotiations between between Anthem and NGHS are reminiscent of the insurer’s dispute with Piedmont Healthcare in 2018.

At the time, Blue Cross Blue Shield, Anthem’s predecessor, couldn’t reach an agreement with the healthcare system, putting some 600,000 state workers at risk of being pushed out of network. The state workers included more than 1,300 University of North Georgia employees.

“My administration will not sit idly by during this contract dispute and leave our state and university system employees, teachers and their families in the balance,” former Gov. Nathan Deal said in a statement in April 2018. A deal was reached in mid-April that year.

And now in 2019, Anthem has asked NGHS to take “drastic cuts” in payments that could negatively affect patient care, according to McNeilly.

He said the health system wants to clarify that for now, nothing is changing, and they want to minimize impact to patients. And the negotiation of contracts is fairly routine, he said, but NGHS wanted to keep patients updated through the process.

“We value our relationship with Anthem and are dedicated to reaching an agreement that avoids any disruption in care to patients with Anthem health insurance,” McNeilly said in a statement to The Times. “Patients shouldn’t make any changes now — and they should continue to use NGHS facilities and physicians. We will keep our patients informed as the negotiations progress.”

Within the health system, more patients are covered by an employer-issued Anthem plan than by any other insurer, McNeilly said. And the portion of the community covered by Anthem could be larger than what’s currently reflected in NGHS records.

“Because there are many in our community who may have Anthem insurance and simply not needed healthcare recently, we are unable to accurately determine the number of people who may be affected,” McNeilly said.

Tina Gaines, communications director with Anthem, said Anthem’s Georgia representatives will continue to negotiate with NGHS over the next few months.

“Our number one priority during these negotiations is to protect consumers’ access to affordable, high-quality healthcare,” she said in a statement to The Times. “We believe hospitals and doctors should be compensated fairly, and this is reflected in the terms we offer to providers to participate in our networks all across Georgia.”

Regional events