High probability NGHS will be dropped by United Healthcare

GAINESVILLE - Northeast Georgia Health System (NGHS) officials said the likelihood is very high that Northeast Georgia Health System will be dropped from the UnitedHealthcare (United) network.

But in statement from UnitedHealthcare Southeast Region Public Relations Director Tracey Lempner, the company remained hopeful in the 11th hour.

“We remain committed to continuing to engage in good-faith discussions with Northeast Georgia Health System and we are hopeful we will reach a mutual agreement that is fair for both parties.”

NGHS’ current contract with United is set to expire Tuesday. Unless a new agreement is reached, NGHS and its physician group, Northeast Georgia Physicians Group (NGPG), will be considered out-of-network for patients with United insurance, beginning tomorrow. All patients with a United commercial insurance product, not a Medicare product, are affected.

“We’ve worked very hard to avoid this outcome, and this is not what we want for our community,” said Melissa Tymchuk, a spokeswoman for NGHS. “We met with United multiple times last week, but there is still significant work to be done. As it stands today, we have no other option but to begin to prepare our patients for this unfortunate change.”

On Friday, NGHS and NGPG began to contact patients with United insurance who are scheduled for appointments or procedures after August 21 to assist them with their options.

”The best way for patients to understand how this network change affects their coverage at Northeast Georgia Health System is to remain in close contact with their health benefits administrator” said Tony Herdener, Chief Financial Officer for NGHS. “Situations like this cause a great deal of uncertainty and stress for our patients, and it is regrettable that a resolution could not be achieved with United. From the beginning of our discussions with United, we made them aware of our goal to reach a new contract well in advance of the contract expiration.”

NGHS began the negotiation process with United in January of this year and set a goal to complete it at least 60 days prior to the deadline.

According to Herdener, contract terms about reimbursement rates, the issue that often causes the most disagreement in managed care contract negotiations, have for the most part been settled for some time. The primary issue that remains outstanding is around contract language related to the possibility of patients not being able to access Northeast Georgia Medical Center at full benefit levels, according to the hospital.

“The terms we have been negotiating for the new contract are based on NGHS being able to serve United patients in our community in the same manner that we have for many years, a critical point to this contract,” says Herdener.

“NGHS has contracts with many other insurance carriers, and we hope that our patients and area employers will consider switching to another insurer so they can guarantee in-network access to our facilities and their trusted physicians,” said Tymchuk. “However, we are committed to continue working with United right up until the contract deadline in hopes that we may be able to come to a resolution.”

For more information or updates on NGHS’ contract negotiations with United, visit www.nghs.com/united.

Link: Northeast Georgia Health System