ATLANTA — In just three days, a contract is set to expire between UnitedHealthcare and Wellstar Health System. That means thousands of patients stand to lose their in-network doctors, or could be forced to pay out of pocket if the two sides can't reach a deal by Oct. 3.
UnitedHealthcare says if an agreement is not reached, 80,000 insured members could find themselves with doctors now outside their network.
Wellstar patients, insured with UHC, received a letter in the mail, stating "Wellstar is a not-for-profit organization" while "UnitedHealthcare is choosing profits over patients."
In a statement sent to 11Alive, UHC counters that, saying "Wellstar's hospitals are already the most expensive in Atlanta, yet it's demanding a more than 16% price hike, driving up healthcare costs."
Jillian Smith is one of the 80,000 UHC members who may have to leave the Wellstar system if they can't reach a deal. She got a letter in the mail.
"Would be nice if, while they reach out to people, it wasn't just telling us why the other person or company is wrong, but also telling us what we can do and who we can reach out to, to get the services we need," she said.
Smith's insurance comes through her husband's employer. They just had a baby three months ago.
"I just didn't want to have to change my son's pediatrician because there was just a lot going on after he was born and I want to make sure that the pediatrician is a good fit," she added.
For perspective, Wellstar has 11 hospitals in the state. UHC says its members can still choose from more than 20 hospitals in the Atlanta area.
"I immediately was upset because my pediatrician is with Wellstar, my OBGYN is with Wellstar, my primary care [doctor] is with Wellstar," she added.
Emory law professor Randy Kessler cautions patients that discussions like this one happen often, and are usually resolved by the deadline.
“I cannot imagine that this large insurance company is going to tell its customers that you can no longer go to Wellstar," he said. "So there's either going to be a deal, or maybe it'll be like the U.S. government, they do a temporary band-aid and they say, let's keep the rates in place for another month while we continue to negotiate.”
Smith turned to Facebook groups for answers and found that many people are going through the same situation. Some folks advised waiting it out, others suggested other pediatricians who accept UHC insurance.
Kessler believes it's just a matter of "when" the two sides reach a solution.
"There are people that work in insurance that are saying Wellstar is holding out, and they're overcharging. Now UnitedHealthcare is going to tell the world, Wellstar wants to overpay people, they want to overcharge," he said. "It's very hard for an insurance company to say to their customers, well, you're not gonna be able to go to any of these 11 hospitals."
A health law expert 11Alive spoke to on the phone suggests first calling UHC for answers, then reaching out to your employers' human resources for suggestions, and also calling the state attorney general's office to talk about your concerns.
"It's a heck of a lot of people if you think of it," Kessler added. "It's 80,000 customers for Wellstar. What business can tolerate a loss of 80,000 customers?"
Wellstar sent a copy of its statement to 11Alive.
For several years, Wellstar Health System has been working to renegotiate a contract with UnitedHealthcare that ensures access to the high-quality healthcare services that Wellstar provides.
- UnitedHealthcare is prioritizing profits over patients.
- UnitedHealthcare has been woefully underpaying Wellstar for years.
- UnitedHealthcare has not been paying its fair share of healthcare costs for the communities we serve.
- UnitedHealthcare is allowing the negotiations to fail.
Wellstar is simply seeking an agreement similar to what we have with other health insurance providers, including fair treatment of independent physicians who are part of Wellstar’s partner network.
- As of October 3, 2021, commercially insured UnitedHealthcare members will no longer have access to in-network services from Wellstar. We encourage them to call the member services number on the back of their insurance card or call Wellstar at (770) 956-STAR or (770) 956-7827 for guidance.
- UnitedHealthcare Medicare Advantage members (other than State Health Benefit Plan for Retirees by UnitedHealthcare) have in-network coverage through the end of the year and should talk with their insurance broker or visit Medicare.gov to select a new plan.
- The current contract negotiations do not affect coverage for patients with the AARP Medicare Supplement from UnitedHealthcare or State Health Benefit Plan for Retirees by UnitedHealthcare.
Wellstar is continuing to ask UnitedHealthcare to negotiate in support of Georgia patients. We are hopeful that we will come to an agreement. More information and regular updates are available at www.wellstar.org/UHC.
UnitedHealthcare also sent a statement to 11Alive.
“Wellstar’s hospitals are already the most expensive in Atlanta, yet the health system is demanding a more than 16% price hike that would drive up health care costs by $56 million for Georgia residents and employers in just one year. This is simply not sustainable or affordable for the people we serve in Atlanta. We are asking Wellstar to come to the negotiating table with a realistic proposal that will help make health care more affordable.”
UHC also mentions that Wellstar has confirmed it will continue to provide care to members enrolled in the UnitedHealthcare Group Medicare Advantage National PPO plan, including the Medicare Advantage State Health Benefit Plan for retirees.