ATLANTA — Georgia patients who have been caught in a dispute between their insurance company and health care provider will again be able to see their doctor without burdensome out-of-network costs.
The agreement was announced last week.
Anthem Blue Cross Blue Shield customers on Pathways plans who rely on WellStar facilities were left in limbo in May when an extension on an agreement between the two to provide access ended.
The dispute dates back to last year when Anthem terminated its agreement with WellStar for the Pathways plans available through federal Affordable Care Act exchanges.
But a lawsuit alleges that customers were duped by Anthem, which they said listed WellStar as an in-network provider during last year’s open enrollment period.
Anthem agreed to extend coverage for a 90-day period as a Feb. 4 deadline to resolve the issue came and went. But that extension lapsed in May and left Anthem Pathways patients facing out-of-network costs to see their regular doctors and specialists.
The Georgia Department of Insurance announced last Wednesday, though, that the matter would be resolved at least through the end of the year.
The department said Anthem had agreed to extend in-network status to WellStar facilities for Anthem Pathways plan holders through the end of 2019, retroactive to Feb. 4.
The agreement applies to primary care physicians and specialists but does not cover inpatient hospital admissions or outpatient services.
Anthem was under scrutiny from the Department of Insurance in the matter and were subpoenaed in May to appear before the state insurance commissioner at the time, Jim Beck.
As part of its agreement with the state of Georgia, Anthem is not admitting any violation of the Georgia Insurance Code with its practices during the last open enrollment period. It’s not clear what effect this will have on the $5 million federal class-action suit that was pending against Anthem.
“It’s like the bait and switch,” a patient represented in the lawsuit, Frances Kirby, told 11Alive in February. “We start seeing the doctors in January and are told, ‘Oh, you know, as of Feb. 4, WellStar will no longer be in the system.’’
The Department of Insurance’s Consumer Services Division is available at 404-656-2070 to help consumers with questions about how they may benefit from the agreement, a news release said.
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