The Affordable Care Act health insurance exchange opens for business on Nov. 1. Georgia is on track to expand its market from four companies to six companies offering plans. (PHOTO by Joe Buglewicz/The New York Times)

Anthem/Blue Cross individual plans won’t have WellStar next year

WellStar patients in northwest Atlanta who had Anthem individual insurance policies through the Affordable Care Act will likely have two alternatives to get their care covered in 2020. But Anthem won’t be one of them.

WellStar, by far the dominant health care provider in Cobb County, told the Atlanta Journal-Constitution Thursday that it had been unable to come to terms with Anthem after the carrier shocked its individual customers this year by dropping WellStar from their network.

“This matter has not been resolved and therefore, WellStar hospitals and its physicians will not be participating” in Anthem’s exchange plans in 2020, the statement said.

One of the new options is Oscar Health, which confirmed it intends to enter the Georgia market, including in Cobb, pending approval by federal regulators.

The AJC reported last week that Oscar Health had filed initial plans to join the market. But at that time the company stressed it had not made a final decision to come to Georgia.

If all goes as planned Georgians in eight counties will have access to Oscar Health policies when the Affordable Care Act exchange opens up Nov. 1, said a spokesman, Brad Weekes. Oscar plans to offer policies in Butts, Clayton, Cobb, Douglas, Fulton, Paulding, Spalding and Troup counties.

WellStar has also renewed its ACA contract with Ambetter, making for two health insurance networks for individual health insurance customers who go to WellStar, its dozen hospitals and its thousands of health care providers.

A second company, CareSource, has also said it intends to join the Georgia exchange, expanding the state’s ACA market to six health insurance companies.

CareSource won’t be in Cobb. No company will be in every county, but every Georgia county should be covered by at least one company.

It’s been a rocky road for Anthem customers. Anthem policyholders in Cobb County, where WellStar hospitals and health care facilities dominate, were already locked into their 2019 policies when they got the news that Anthem would no longer have WellStar in its network effective Feb. 4. They had 11 months left to go with their hospitals or doctors out of network. Anthem is formerly known as Blue Cross Blue Shield of Georgia.

Georgia regulators hoped federal regulators would open up a special enrollment period for those customers and let them switch companies. But that didn’t happen.

Patients sued. The state got some minor concessions from Anthem. But so far Anthem has largely continued its WellStar pullout and customers must remain in those plans through December.

Oscar Health touts its focus on technology, and was co-founded by Josh Kushner, brother of the presidential adviser and son-in-law Jared Kushner.

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