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Posted: Tuesday, August 14th 2012 at 11:49am

NGHS prepares to be out of network with United Healthcare

EMAIL STORY CONTACT EDITOR PRINT
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GAINESVILLE – Northeast Georgia Health System (NGHS) announced Monday that it is preparing to be out of network with United Healthcare.

The current contract between NGHS and United is set to expire on Aug. 21, and unless a new agreement is reached by this date, Northeast Georgia Medical Center and its physician group, Northeast Georgia Physicians Group, will be considered out-of-network for patients with United insurance.

"This means many families across Northeast Georgia will have limited access to our facilities and our physician group and may be required to leave the area for the services they now receive close to home unless they want to pay higher out-of-pocket costs imposed by United” said Melissa Tymchuk, a spokesperson for Northeast Georgia Health System. “We are committed to continuing discussions up to the deadline with United, but are growing increasingly concerned. We’re taking steps to prepare for the worst and want to be ready to help our patients through this.”

NGHS began the negotiation process with United in January of this year.

“It was our intention to complete this process at least 60 days prior to the deadline, but we were met with numerous delays on the part of United,” added Tymchuk. “We pressed forward, and in fact, most contract terms about reimbursement rates have been settled for some time. However, we are not willing to compromise on contract language that threatens our financial stability, limits our ability to improve coordination of care in the future, or puts quality of care at risk. We can’t accept an agreement that harms our patients’ future local access to in-network care or relationships with their valued healthcare providers.”

Tymchuk said patients with United insurance can continue to receive care at NGHS facilities and from Northeast Georgia Physicians Group between now and the August 21 deadline. NGHS and NGPG physicians are still in-network with United until the contract expires or if a new agreement is reached.

“We know this situation causes concern, and we want nothing more than to resolve this so we can continue to care for our patients at full in-network benefit levels and at a lower cost to them,” said Tymchuk.

NGHS facilities affected by the United contract include:
• Northeast Georgia Medical Center
• All Northeast Georgia Physicians Group locations and physicians
• Urgent Care (all locations including Braselton, Buford and Gainesville)
• Imaging Center (all locations including Braselton and Gainesville)
• The Rehabilitation Institute (all locations including Braselton, Buford, Cleveland, Dahlonega, Dawsonville, Gainesville and Oakwood)
• The Toccoa Cancer Center
• Hospice of Northeast Georgia Medical Center

If an agreement is not reached, Tymchuk said NGHS is prepared to do everything it can to help patients understand their rights and how their out-of-pocket costs will change for care. Regardless of the outcome or a patient's benefit plan, she said emergency services are always covered with no additional out-of-pocket costs to the patient, even if NGHS is dropped from the United Network.

In addition, certain patients may be granted in-network status by United after the Aug. 21 termination date because state law requires that their care be covered as an in-network benefit under Continuity of Care provisions, according to Tymchuk. Patients who are hospitalized, pregnant or currently undergoing active treatment for an acute or chronic condition may qualify. She said patients should contact United to determine if their care or procedure will continue to be covered as an in-network benefit after Aug. 21 because of their condition.

Tymchuk said switching insurance coverage is another option to ensure in-network access to NGHS facilities and Northeast Georgia Physicians Group doctors if an agreement is not reached.



Link: More information or updates on NGHS’ contract negotiations with United
Associated Categories: Homepage, Local/State News

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