St. Joseph's hospital's deadline insurance deal keeps patients insured

By Craig Schneider

The Atlanta Journal-Constitution

Thousands of St. Joseph’s Hospital patients won’t have to seek hospital care elsewhere or pay higher bills because the facility has reached a last-minute contract agreement with insurer United Healthcare.

Officials said they reached the agreement some 20 minutes before the contract was set to expire midnight Friday.

The two-year agreement keeps the patients of the Sandy Springs hospital in the insurer’s network and prevents what could have been an interruption in their insurance coverage had the deal fell through.

In 2008, about 8,500 patients coming through St. Joseph’s were United Healthcare members.

The new contract provides the hospital with better rates of reimbursement from the insurer, regarding the costs of outpatient procedures such as the installation of pacemakers and heart stents, said Kevin Brenan, St. Joseph’s senior vice president and chief financial officer.

He noted that more and more procedures are performed on an outpatient basis, and the insurance contract had to reflect these changes.

United spokesman Roger Rollman declined to discuss the specifics of the contract, except to say the contract is mutually acceptable to both parties.

St. Joseph’s patients will see no changes in their access to services or their out-of-pocket expenses due to the new contract, Brenan said.

The down-to-the-wire negotiations had worried some people who use St. Joseph’s services and doctors. Many had received letters about a month ago warning that their coverage could end. In recent days, hospital officials said negotiations had taken a cooler turn.

“As in any business discussion with a termination looming, both parties evaluated the other business in terms of their long-term goals,” Brenan said. Some “win-win creative solutions” by both parties helped seal the deal, he added.

If the contract had expired, patients may have had to seek their hospital care at some other metro Atlanta hospital covered by United Healthcare. Some patients who use doctors exclusive to St. Joseph’s may have had to seek out other doctors covered by United.

If people wanted to continue using St. Joseph’s, they would have paid much higher “out-of-network” insurance costs.

It is not unusual for contract negotiations between hospitals and insurers to go down to the wire, but these talks pushed even that expectation, Rollman said.

WellStar Health System, which operates five hospitals in metro Atlanta, has been in rocky contract renewal negotiations with Aetna insurance company. That contract expires Aug. 31.