Another contractual stalemate looms between United and Northside
Three months ago, two hospitals in Northside in Gwinnett County went out of the network with UnitedHealthcare, affecting thousands of insurance company members.
There is now the potential for other Northside hospitals – including the healthcare system’s flagship facility in Atlanta – to also withdraw the United provider network, with possibly more patients affected.
The existing contract between the insurer and Northside Hospitals in Atlanta, Forsyth County Seat of Cumming and Cherokee County Seat of Canton expires on August 1.
Northside Hospital Atlanta says it delivers more babies per year than any other community hospital in the country. It’s unclear exactly how a possible contract termination would affect pregnant women planning to give birth in Northside.
United said in a statement to GHN on Monday that “Northside hospitals in Atlanta, Cherokee and Forsyth are the most expensive in Atlanta, and for cancer patients, they are among the most expensive places across the country to receive care “.
United accused Northside of increasing the cost of drugs administered by doctors, “increasing its results at the expense of its patients.”
“Despite these high costs, Northside is demanding double-digit price hikes over the next three years, which would dramatically increase health care costs,” the United statement continued. “We call on Northside to work with us to help make healthcare affordable for the residents and employers we serve in Georgia.”
The insurer said it was in active talks with Northside to keep the networked hospitals at affordable rates.
Northside, a non-profit scheme, said in a statement Monday night that he and United “had been in regular discussions for some time. While we have not come to an agreement on what is best for Northside patients who have lost their health care coverage, we are committed to correcting this situation. We hope United will do the same.
Contract negotiations between insurers and hospitals sometimes become public and acrimonious, but are usually settled before a renewal deadline.
But Northside Gwinnett Hospital in Lawrenceville and Northside Duluth Hospital in western Gwinnett County have been out of United’s network since March 1.
A contract lapse is an unusual outcome of negotiations between insurers and healthcare systems, said Josh Berlin, CEO of Rule of Three, a healthcare consultancy. “Typically, there are motivators for both parties to maintain the same pricing structures and keep patients in a network. “
United said by the time the Gwinnett contract ended that around 5,000 members had received care at one of Gwinnett’s two facilities over the previous year and had been notified of the network change.
Northside Hospital acquired the old Gwinnett system, including Lawrenceville and Duluth hospitals, in 2019. Gwinnett is the second most populous county in the state.
The termination of the contract did not affect United’s contract with the doctors employed by Northside Gwinnett.
Recently, UnitedHealthcare drew fierce criticism nationwide after it said it would stop paying for non-emergency emergency room visits. The policy to review and potentially crack down on certain hospital payments has come under attack from the hospital industry and emergency room physicians, with critics warning of potential harm to the health and finances of patients.
In a statement last week, the Minnesota-based insurance giant said the emergency policy change would be postponed until the pandemic ends.
Berlin said contract terminations between hospitals and insurers can disrupt care for patients undergoing treatment, such as for cancer, heart problems or pregnancy.
“This is a great opportunity for employers to play more of an advocacy role to help prevent this happening as we see an increasing intersection of supplier-employer activity in markets,” he said.