Piedmont Healthcare, one of metro Atlanta’s biggest hospital systems, reached a deal Saturday with insurer UnitedHealthcare that restores “in-network” access to Piedmont facilities for United customers.
The new contract between the two giants ends a nearly two-month standoff that had left thousands of United members in the area with a choice of facing potentially higher costs or finding new providers.
It also comes just before open enrollment at many workplaces for 2017 coverage, and as employers choose health plans to offer their workers.
Especially for people living in Atlanta’s southern suburbs, Piedmont’s absence would have put a big hole in United’s network. Piedmont’s hospitals in Stockbridge, Newnan and Fayetteville have a dominant position south of Atlanta’s airport.
The renewed agreement is retroactive to July 1, ensuring that United members who received Piedmont services since the old contract expired will not have to pay extra for being out of network during that time.
“No claims will be considered out of network,’’ Daryl Richard, a United spokesman said Saturday.
The deal covers Piedmont Atlanta, Piedmont Fayette, Piedmont Mountainside, Piedmont Newnan, Piedmont Henry and Piedmont Newton hospitals, as well as the 1,400 Piedmont Clinic physicians.
The contract impasse gained wide attention due to the size of the two players. Minnesota-based United is the nation’s largest health insurer, and Piedmont is one of Georgia’s most important health care systems, due to its huge metro Atlanta footprint.
The two sides had traded verbal shots since the original deal expired July 1, with Piedmont saying United was fixated on profitability and shareholders, and United saying Piedmont’s demand for 30 percent in reimbursement increases was unsustainable.
Negotiations accelerated last week, with an all-day meeting Monday being pivotal, said Matt Gove, chief consumer officer at Piedmont. Reimbursement terms in the deal weren’t disclosed, but Piedmont CEO Kevin Brown said the sides found “common ground.”
“Our priority is our patients and this process has been very tough on them,’’ Brown said in a statement. “We are very happy to have found common ground and a way that Piedmont and UnitedHealthcare can work collaboratively to extend high-quality, patient-centered care in our communities.”
Two sticking points from United’s standpoint were resolved. Piedmont agreed to move its hospitals into United’s pricing and quality “transparency’’ Web tool for consumers. Its physicians were already participating in that mechanism. And the new contract puts more emphasis on “value-based’’ performance, which generally rewards or penalizes providers based on health outcomes — a trend in health care reimbursement.
Richard, the United spokesman, said Saturday that the company had alerted employer “customers,” such as Delta Air Lines, that a new deal had been struck.
Delta and another Atlanta-based corporate giant, the Coca-Cola Company, had communicated with both sides about getting a new deal done, noting the issue’s importance to their Georgia employees.
Gove said Piedmont plans to have its physicians’ offices open extra hours for patients who had been waiting to get services.
Andy Miller is the CEO and editor of Georgia Health News.This article was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
About the Author
