The latest on contract talks between Northeast Georgia Health System and UnitedHealthcare

Jeff Gill, The Times, Gainesville, Ga.
Updated ·3 min read

Mar. 22—Contract extension talks are coming down to the wire between Northeast Georgia Health System and UnitedHealthcare.

The contract, expiring April 30, covers care at all NGHS facilities, including all Northeast Georgia Medical Center hospitals, Northeast Georgia Physicians Group practices, Urgent Care locations, Georgia Heart Institute locations, Laurelwood, long-term care facilities and outpatient centers.

And the war of words is heating up.

"UnitedHealthcare has let you down," NGHS says on a website devoted to the talks.

"Despite our continued best efforts, we remain very far apart on key contract details. United wants to limit access to imaging, surgery and other services and is unwilling to pay equitably for the care you need. We simply cannot accept a contract that threatens our ability to care for you the same way we have for nearly 70 years."

And UHC said in a statement that NGHS "is demanding a near 25% price hike over the next three years, which would make its hospitals the most expensive in Georgia.

"These demands are not sustainable and would significantly drive up health care costs for the people and employers we serve in Northeast Georgia. One of our self-funded customers would see their health care costs increase by more than $3.5 million. We ask that NGHS join us at the negotiating table with a realistic proposal that's affordable for consumers."

NGHS said in response to the price hike it "is actually only asking for a single-digit increase to bring UnitedHealthcare in line with other commercial insurance companies."

As for those affected by the contract talks, NGHS says on its website, "Only UnitedHealthcare commercial (employer-sponsored) health plans are impacted by the negotiations."

And UHC says in a statement, "If we are unable to reach an agreement, NGHS will no longer participate in our network for employer-sponsored and individual plans and our Veteran Affairs Community Care Network, effective May 1, 2023."

UHC projects "total membership impact is just more than 12,000."

AARP Medicare Supplement insurance plans insured by UHC aren't affected, according to the insurer.

Does all the fighting seem like deja vu?

NGHS and Anthem were engaged in a similar battle in 2019.

Negotiations dragged past a Sept. 30 deadline that year, with the two parties finally reaching an agreement in January 2020.

In that case, NGHS had agreed to honor in-network rates for Anthem patients past the deadline until Dec. 31, saying it was taking a loss of about $10 million per month. When an agreement had not been reached by Jan. 1, Anthem patients became out-of-network with most NGHS facilities.

NGHS notes on its UHC website that people admitted to the hospital before April 30 will be covered at in-network rates through the end of their inpatient stay.

Also, "certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment prior to the contract end date may qualify" for continued care at in-network rates for a "defined period of time."

Those patients must apply before April 1.

And NGHS also says that "new legislation in Georgia provides extended coverage to some patients as if they were in-network until Oct. 27."