Atlanta’s biggest health contract dispute in years is over.
Grady Health System and Blue Cross and Blue Shield of Georgia announced they have agreed to a new contract effective April 1.
Their contract lapsed in late November, when they failed to negotiate a new one before the deadline. The collapse was surprising because payment disputes between insurers and hospital systems are almost always resolved before an existing agreement expires.
For four months, Grady Memorial Hospital was “out of network’’ for Blue Cross health plan members, who faced higher out-of-pocket costs at the Atlanta facility.
The dispute was widely watched in health care circles and also helped prompt legislation in the General Assembly.
“We are pleased to announce that we have reached a fair and sustainable agreement,” Morgan Kendrick, president of Blue Cross, said in a statement. “Historically [Blue Cross] and Grady have worked together to provide access to quality medical care. We look forward to continuing this relationship for many years to come.”
John Haupert, president and CEO of Grady, said, “This new agreement means that Blue Cross members once again have access to the unparalleled skill and experience that Grady provides area residents.”
After the contract expired, Grady launched a media campaign asserting it had been underpaid by Blue Cross for years. The insurer said it had paid Grady no differently from any other large urban hospital in Georgia.
Pending state legislation would require the state employee and teacher health plan to include the state’s five Level 1 trauma centers as “in-network” facilities. That would force Grady, a trauma center, to become in-network for the State Health Benefit Plan, where Blue Cross is the dominant insurer.
Haupert had told lawmakers that because of the out-of-network status, state health plan members had left the facility still owing thousands of dollars. The adequacy of insurers’ networks has been a hot topic since the creation of the Affordable Care Act exchanges, which prompted consumer complaints about limited choice of providers.
In February, the chairwoman of a key House health panel accused Blue Cross of acting as a “bully’’ in its dealings with medical providers.
State Rep. Sharon Cooper (R-Marietta) also said Blue Cross “disrespected” the House Health and Human Services Committee by failing to send a representative to a meeting at which complaints against the insurer were discussed.
Chris Kane, a consultant with Dixon Hughes Goodman Healthcare, said an agreement was inevitable.
“Both organizations have a high profile in Georgia health care,’’ Kane said. “For Grady, it was a substantive financial issue; for Blue Cross, a noticeable public relations issue.”
This story was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.Andy Miller is the CEO and editor of Georgia Health News.
About the Author
