Hundreds of thousands of metro Atlanta residents with Anthem insurance have now been assured full network access with Northside Hospital facilities and doctors, as the two sides announced a new contract agreement Tuesday.
The dispute between Georgia’s largest insurer and Northside had dragged on since last year. But a Fulton County judge had spared patients from losing network access Jan. 1 by issuing an injunction, keeping the contract in place while Northside and Anthem worked out a deal.
At the time, an estimated 400,000 metro Atlanta patients with Anthem Blue Cross and Blue Shield insurance had recently used Northside hospitals, clinics and doctors.
But a deal still proved elusive, and in April, Judge Rachelle Carnesale ruled that Northside and Anthem had to take their contract battle to the state department of insurance for settlement.
The insurer and the five-hospital system also argued their cases before the Georgia Supreme Court in May, At issue was a state law that prohibited an insurer from ending a contract with a medical provider during a public health emergency like the pandemic.
In past years, such contract disputes over reimbursement rates typically would be resolved before termination of a deal. Recently, though, more contracts have lapsed without a deal, leaving patients in limbo on whether to stay with a current medical provider but face higher costs.
The Northside-Anthem agreement follows a settlement of another long contract rift. Late in June, UnitedHealthcare and Marietta-based Wellstar Health System reached a multi-year agreement that restored network access to an estimated 80,000 people. They had been out of network since early October.
Dave Smith, a local health care consultant for Kearny Street Management, said that employers became involved in the Northside-Anthem matter, making phone calls to the insurer pushing for a contract resolution. Some companies actually switched to a new health plan to keep employee access to Northside facilities, he said.
With hospitals seeing their labor and supply costs rising, negotiations with health insurers will continue to feature tough bargaining and potential contact termination, Smith added. “The insurers are all trying to bring rates down.”
Anthem is the metro Atlanta market’s heavyweight health insurer, while Northside’s system includes an Atlanta hospital that its leaders say delivers more babies than any other community hospital in the nation — more than 15,000 a year.
Both sides praised the agreement Tuesday.
“Northside Hospital has an unwavering focus on patients and their families, and that always is our mission,” Scott Wade, vice president of Northside Hospital, said in a statement. “The outcome of our discussions is great news for our partnership with Anthem Blue Cross and Blue Shield and our patients.”
Robert Bunch, president of Anthem Blue Cross and Blue Shield in Georgia, said in a statement, “I’m pleased we were able to come to a resolution on behalf of our members. Our new agreement with Northside continues and enhances our partnership, continuing access to quality care for Georgians, which is our focus.”
Andy Miller is senior editor of the Southern Bureau of Kaiser Health News
