In several states around the country, stalled contract negotiations between hospital systems and insurance companies are affecting access to trusted physicians and hospitals and complicating decisions about patient healthcare.
In Georgia, more than 80,000 patients no longer have in-network coverage for physicians and healthcare professionals at Wellstar Health System after negotiations between UnitedHealthcare (UHC) and Wellstar failed to result in a viable agreement before the contract terminated on Oct. 3, 2021. Now, UHC’s members who live in Cobb, Paulding, and Douglas Counties must leave their home counties for in-network hospital care.
Credit: Robin Rayne
Credit: Robin Rayne
Additionally, because Wellstar’s hospitals are not in-network, many UHC members have severely limited options for in-network, lifesaving trauma care. Other hospital systems are having the same problems. Northside is in litigation with Anthem BCBS because the insurance company is trying to terminate their contract. Thankfully, a judge has an order in place that gives the parties until April 15 to reach an agreement, using HB 454, a bill that I carried in the Senate, in the decision. If this is not resolved, thousands of patients will become out-of-network.
As an orthopedic surgeon and healthcare advocate for North Georgia families in the Georgia State Senate, I am extremely concerned about the impact of patients postponing care due to out-of-network coverage and the fear of high medical bills. The long-term health of community members in my district – and across our state and country – is a real concern when insurance providers will not come to a fair agreement with health systems.
I am also concerned about how misleading information and misdirected allegations related to contract negotiations have played out publicly and the impact this may have on public trust in our healthcare systems. Leaving Georgians without covered access to physicians and healthcare professionals they know and trust adds to the frustration, confusion and anger of patients in our communities.
Communities suffer when insurance giants fail to reach a fair agreement with local hospital systems. These rate disputes threaten both patient care and the health systems we all depend on to provide that care 24/7 in our communities. The timing of the current fights is highly problematic, as our hospitals and doctors have been challenged by the COVID pandemic for the last two years.
Wellstar, Northside and other local hospital systems not only invest in delivering high-quality patient care, but also invest significantly in the communities they serve.
It is in the best interest of all stakeholders to consider the impact these disputes, stalled negotiations and network disruptions have on patient care and outcomes. As Wellstar, Northside, and other hospital systems continue to work to get insurance companies to engage in meaningful negotiations to reach a fair agreement, the pandemic has taught us that we need to put patients and communities first, while supporting our healthcare providers and frontline workers – not put them at a disadvantage.
Let’s care for those who care for us.
State Sen. Kay Kirkpatrick, M.D., R-Marietta, represents Senate District 32.
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