Northeast Georgia Health System has gone out of network with UnitedHealthcare’s employer-sponsored and individual plans due to a contract impasse. The split will affect about 12,000 patients. If patients desire to continue receiving care from Northeast Georgia Health System while still being covered by UnitedHealthcare’s policies, they will either need to find other medical professionals or pay out-of-network fees. Some patients, including pregnant women or individuals undergoing active medical treatment for cancer, may be eligible to continue their care at in-network rates. The split highlights the challenges of negotiating contracts in the healthcare industry and the impact on patients.
Northeast Georgia Health System (NGHS), based in Gainesville, has gone out of network with UnitedHealthcare’s employer-sponsored and individual plans. The decision came after the two parties were unable to reach a new contract. The split will affect approximately 12,000 patients of Northeast Georgia Health System, and some may qualify to continue their care at in-network rates, including pregnant women or individuals undergoing active medical treatment for cancer. This article will delve deeper into the reasons behind the split and its potential impact on patients.
Reasons Behind the Split
The reason behind the split between UnitedHealthcare and Northeast Georgia Health System was a contract impasse. The two parties were unable to reach an agreement on the terms and conditions of the new contract, leading to a breakdown in negotiations. The negotiations reportedly broke down due to disagreements over reimbursement rates and other financial terms.
Northeast Georgia Health System released a statement on May 1, stating that the hospital system had been negotiating with UnitedHealthcare for several months to try and reach an agreement that would be beneficial for both parties. However, despite their best efforts, they were unable to agree, and as a result, Northeast Georgia Health System decided to terminate its contract with UnitedHealthcare.
UnitedHealthcare also released a statement on May 1, expressing disappointment at the decision made by Northeast Georgia Health System to terminate their contract. They said that they had been in negotiations with Northeast Georgia Health System for several months and had offered a “fair and reasonable” proposal that would have been beneficial to both parties. However, Northeast Georgia Health System rejected their proposal, leading to the termination of the contract.
Impact on Patients
The split between UnitedHealthcare and Northeast Georgia Health System is expected to affect approximately 12,000 patients. To continue receiving care from Northeast Georgia Health System while still being covered by UnitedHealthcare’s employer-sponsored and individual plans, patients will either need to find new doctors or pay out-of-network fees.
Some patients, however, may qualify to continue their care at in-network rates. According to a report by radio station WABE, pregnant women or individuals undergoing active medical treatment for cancer, as well as patients with newly diagnosed or relapsed cancer, may be eligible to continue their care at in-network rates.
The report also stated that patients with ongoing medical conditions may be able to receive in-network coverage for a limited time. However, patients will need to contact UnitedHealthcare to verify if they qualify for in-network coverage.
Patients who are unable to continue their care at Northeast Georgia Health System due to their out-of-network status may face challenges finding new providers, especially in rural areas where access to healthcare is limited. They may also face higher out-of-pocket costs for medical care.
