By allowing ads to appear on this site, you support the local businesses who, in turn, support great journalism.
Why a tax mixup caused some Northeast Georgia Diagnostic Clinic patients to lose coverage
NGDC
Northside Hospital acquired the Northeast Georgia Diagnostic Clinic in Gainesville in 2018. - photo by Jeff Gill

At least 1,600 patients of the Northeast Georgia Diagnostic Clinic in Gainesville could be looking for new health care providers after the clinic announced this month that it is no longer serving individual plans covered by Alliant Health.

“It was not our intent … we did not withdraw from Alliant,” said Bill Beyer, CEO of the diagnostic clinic.

The change comes immediately after Northside Hospital completed its acquisition of the diagnostic clinic this month. It was previously owned by a physicians group.

“As a result of that, we had to change our corporate structure,” Beyer said.

And this change included a new tax identification number.

Beyer said all of the major insurance carriers in the local market, including United, Cigna, Humana, Blue Cross Blue Shield and Medicare Advantage programs, accepted the tax ID change.

“We didn’t miss a beat,” he added.

But those providers serve employer and group-sponsored health plans.

Alliant is the only health insurer offering individual plans in Hall County this year.

And individuals can only access Alliant coverage through the insurer’s agreement with Health Partners, which is owned by the Northeast Georgia Health System.

“They in turn forced that situation onto Alliant,” Beyer said. “These (patients) have been left out to fend for themselves.”

Steve McNeilly, vice president of managed care and integration strategies at Health Partners, said his board of directors approved keeping the diagnostic clinic in its network three months ago.

But the tax ID change, which affects billing practices, moved the diagnostic clinic out of network.

“We have not done anything to change the status,” McNeilly said. “This is the piece that’s misinterpreted. That’s what caused all this to happen.”

Northside’s presence in Hall County, while not entirely new, was met with concern by representatives of NGHS when the pending sale of the diagnostic clinic was announced last spring.

McNeilly said Northside could apply to serve Alliant patients again, and at that point would go through a standard eligibility and credentialing process, agreement to terms and rates, and ultimately would need approval from the board of directors.

“They may, they may not,” he added. “Obviously, it’s not what we intended to do at all. Had they kept that old (tax ID) number, we wouldn’t even be having this conversation.”

The loss of coverage for Alliant patients at the diagnostic clinic came abruptly.

Only on Oct. 10 were some patients notified by the insurer that their coverage had been dropped as of Oct. 1.

“I’m still puzzling — why the transition couldn’t have been as smooth for these patients as it was for other patients in other insurance programs,” said Dr. Matthey Harris, managing partner of the diagnostic clinic. “We are certainly open to discussions. We hope we can do what’s best for the patients. We hope every party wants to do that.”

Harris said many patients have showed up for appointments made months in advance only to find out they are no longer covered.

“We don’t want our patients scared and confused,” she said.

Patients at the clinic seek services for endocrinology, oncology and rheumatology, for example, and also see primary care physicians, through their Alliant coverage. The clinic has patients on dialysis and chemotherapy regimens.

For these patients, the impact on continuity of care and access to specialists could be severe.

Some have chosen to pay out of pocket. Others may have to turn elsewhere. And it’s possible others may not get the care they need.

McNeilly said some patients may be able to access care through an affiliate network, though benefit levels and other options in health plans may vary.  

And Beyer said that the clinic does have the ability to provide for some patients with chronic conditions.

“We’re trying to accommodate them as best we can,” he added. 

Regional events