x
Breaking News
More () »

Judge extends injunction keeping Northside in Anthem network

A decision issued on Wednesday places the heart of the dispute before the Georgia Department of Insurance.

ATLANTA — A judge issued a significant ruling Wednesday in the ongoing dispute between Northside Hospital and Anthem Blue Cross Blue Shield insurance.

Most importantly for the 400,000 Northside patients with Anthem insurance who are hoping to remain in-network with the hospital, Fulton County Superior Court Judge Rachelle L. Carnesale extended an injunction that has maintained the status quo for those patients "until further order."

It appears that the injunction will cover through at least June 15. 

That's because the judge ruled Northside and Anthem must take their dispute to the Georgia Department of Insurance - determining that the agency, rather than the courts, should settle the dispute. She set a June 15 deadline for Northside and Anthem to "provide the Court with an update as to the status of the Department of Insurance's review."

RELATED: Fulton County judge makes decision in legal fight between Northside and Anthem

The judge's ruling said Northside and Anthem will have 20 days to submit petitions to the Department of Insurance for such a review from the agency.

As part of that ruling, the judge also halted the discovery process of the legal case until a decision is returned from the Department of Insurance.

The dispute began last year when Anthem notified Northside it wanted to change its contract – alleging Northside was charging more than most metro hospitals.

However, Northside said the contract was not up for renewal and it argued a bill signed into law in Georgia during the pandemic prohibited insurers from terminating a provider’s in-network coverage for up to 150 days after a public health emergency.

On Dec. 30, 2021, a judge granted an injunction, which allowed Northside to remain in-network with Anthem through Jan. 31. That has since been extended a number of times as the case continues.

According to the judge's ruling, Anthem has argued that the Department of Insurance "has exclusive jurisdiction over Northside’s and Cherokee County’s claims" (Cherokee County joined the legal process in January, arguing 47 percent of Cherokee County residents and 55 percent of Cherokee County employees are insured by Anthem and that the lives of those people "are being imperiled by the threatened termination of Northside Hospital and numerous Northside physicians and practice groups from Defendants’ physician network amid the greatest COVID outbreak since the start of the pandemic.")

The ruling indicates the judge agreed with Anthem's arguments over what body is proper to settle the dispute. From the ruling:

As indicated above, the meaning of “public health emergency,” “effective date of the public health emergency,” and “expiration of such public health emergency” as used in O.C.G.A. §33-20C-2 and as applied to the facts herein are essentially the determinative questions in this case. The use of these phrases in this specific statute is peculiar. In this statute, the term “public health emergency” is not defined and is expressly not limited by a definition provided elsewhere in the law. An understanding of the meaning and application of these terms requires a factual and technical inquiry where extrinsic evidence is necessary to determine their meaning or proper application. The Commissioner of Insurance has broad authority to enforce, interpret, and implement Title 33. See, e.g., O.C.G.A. §§33-2-9 and 33-2-24. And these key terms and their application to the present dispute require the technical expertise that is within the special competence of the Commissioner. Moreover, the Commissioner of Insurance, as a member of the executive branch, is in the best position to ensure patients, health care providers, and insurers are all equally protected by O.C.G.A. § 33-20C-2(g)(2).  

Sending the matter to the Department of Insurance, the ruling said, is "warranted, necessary and appropriate."

See the full order below or click here.

   

Paid Advertisement