Habersham Medical Center remains in United Healthcare network
By KIMBERLY BROWN (This article was published in the August 24th edition of The Northeast Georgian.)
To help dispel a “nasty rumor,” Habersham Medical Center Vice President of Finance Jim Peterson wants to get the word out that HMC is still in the United Healthcare network.
However, as many Habersham County school system employees are already aware, Northeast Georgia Health System is not in the United Healthcare network as of Aug. 22, due to a breakdown of contract negotiations.
Habersham County School Superintendent Matthew Cooper and Benefits Coordinator Wanda Gosnell agree Habersham County school system employees are affected, because United Healthcare is one of two vendors under the State Health Benefit Program. The second vendor is Cigna Healthcare.
Cooper said it is a “top priority” for the school system to “go to bat for our employees.”
“We’re sending formal appeals to the State Health Benefit Plan, to United Healthcare, and also to Northeast Georgia Medical Center,” Cooper said. “We want them to understand the sense of urgency.”
Both Peterson and Gosnell said they had been fielding many calls and emails about the issue.
“They’re so frustrated, and I’m so frustrated, too,” Gosnell said of the worried employees.
Gosnell said she has been telling employees to call United Healthcare with their concerns, but, “If they have surgery or anything coming up with [NGMC], they need to get in contact with the hospital.”
Gosnell said an employee can apply for a “continuation” with United Healthcare to possibly be approved for already-scheduled procedures or ongoing treatments.
Reading from the NGHS website, NGHS.com/united, Gosnell said affected entities are Northeast Georgia Medical Center, Northeast Georgia Physician Groups, Urgent Care, Imaging Center, Rehabilitation Institute and Toccoa Cancer Center.
As to why such contract issues did not affect HMC, Peterson said someone “external” to the hospital negotiates HMC’s contracts, “and he did not have any issue with any of the paragraphs in ours [United Healthcare contract].”
“I don’t know which clause that Northeast Georgia is having a problem with,” Peterson said. “But we’re still in network, so teachers and others who have United Healthcare plans [and use HMC] will not be penalized with an out-of-network higher deductible or co-pay.”
A message on the Northeast Georgia Health Systems website states, “This is not what we wanted, and we worked very hard to avoid this outcome. After more than eight months of negotiations and multiple meetings leading up to the contract deadline, we were very surprised when United abruptly ended talks four hours before the deadline without finalizing a new agreement. We are hopeful United will change their position and decide to continue discussions with us that would bring us to a fair resolution. At this point, we have yet to hear from them.”
However, Cooper does not believe the blame lies solely with United Healthcare.
“I believe the truth is, the blame is shared,” he said. “We hear a lot of bad things about insurance companies, but they are negotiating with Northeast Georgia Medical Center for better prices for us. I think everyone needs to realize both sides need to come to some kind of agreement. It’s just a shame that they have not. All the blame cannot be placed on United Healthcare. Northeast Georgia Medical Center needs to step up to the plate and be willing to make a little less money to work out an agreement.”
Cooper said many employees have asked why the school system can’t just drop United Healthcare. He said that is not possible, and employees won’t be able to change providers until open enrollment season in October. However, he said, the school system is working to see if employees may be allowed to change earlier.
“We can’t make any promises,” he said.
“The issue [with dropping United Healthcare] is our retired teachers, many of them with United Healthcare, would lose their benefits,” Cooper said. “It’s an all-or-nothing type thing. We don’t have the option as a school system to just drop United Healthcare, because it’d have such an impact on our retired educators. We’ve got to continue working with United Healthcare and Northeast Georgia Medical Center. The good news is Habersham Medical Center is still in network, and most doctors are.”