Will Northside Hospital drop UnitedHealthcare?

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Three months ago, two Northside hospitals in Gwinnett County went out of network with UnitedHealthcare, affecting thousands of the insurance company’s members.

Looming now is the potential for other Northside hospitals — including the health system’s flagship facility in Atlanta — to drop off the United provider network as well, with possibly more patients affected.

The existing contract between the insurer and the Northside hospitals in Atlanta, in the Forsyth County seat of Cumming and the Cherokee County seat of Canton expires August 1.

Northside Hospital Atlanta says it delivers more babies a year than any other community hospital in the country. How a possible contract termination would affect pregnant women who plan to give birth at Northside is unclear.

United said in a statement Monday to GHN that “Northside’s Atlanta, Cherokee and Forsyth hospitals are the most expensive in Atlanta, and for cancer patients, they’re some of the most expensive places in the entire country to receive care.’’

United accused Northside of marking up the cost of physician-administered drugs, “padding its bottom line at the expense of its patients.’’

“Despite these high costs, Northside is demanding a double-digit price hike over the next three years that would significantly increase health care costs,’’ the United statement continued. “We are asking Northside to work with us to help make health care affordable for the residents and employers we serve in Georgia.”

The insurer said it’s in active talks with Northside to keep the hospitals in network at affordable rates.

Northside, a nonprofit system, said in a statement Monday evening that it and United “have continued regular discussions for quite some time. While we have not reached an agreement on what’s best for Northside’s patients who have lost their health care coverage, we’re committed to fixing this situation. We hope that United will do the same.”

Contract negotiations between insurers and hospitals sometimes become public and acrimonious in tone, but usually are settled before a renewal deadline.

But Northside Hospital Gwinnett, in Lawrenceville, and Northside Hospital Duluth, in western Gwinnett County, have been out of United’s network since March 1. Also out of network now are Northside Gwinnett Joan Glancy, a rehabilitation facility, and Northside Gwinnett Extended Care Center.

A contract lapse is an unusual result from negotiations between insurers and health systems, said Josh Berlin, CEO of rule of three, a health care consulting firm. “Typically there are motivating factors for both sides to keep rate structures the same and keep patients in a network.’’

United said at the time the Gwinnett contract ended that about 5,000 members had received care at one of the two Gwinnett facilities in the previous year and were notified of the network change.

Northside Hospital acquired the former Gwinnett system, including the Lawrenceville and Duluth hospitals, in 2019. Gwinnett is the second most populous county in the state.

The contract termination did not affect United’s contract with Northside Gwinnett’s employed physicians.

Recently UnitedHealthcare drew sharp criticism nationally after it said it would stop paying for non-urgent patient visits to emergency rooms. The policy to review and potentially crack down on some hospital payments was assailed by the hospital industry and ER physicians, with the critics warning of potential harm to patients’ health and finances.

In a statement last week, the Minnesota-based insurance giant said the ER policy change would be put off until the end of the pandemic.

Berlin said contract terminations between hospitals and insurers can disrupt care for patients who are getting ongoing treatment, such as for cancer, cardiac problems or pregnancy.

“This is a great opportunity for employers to play more of an advocacy role to help prevent this occurrence, as we see an increasing intersection of provider-employer activity in markets,’’ he said.