Jordan Ellis
Northside Hospital and Anthem Blue Cross Blue Shield of Georgia have been in a legal dispute, with Northside Hospital pursuing legal remedies to protect the rights of its patients. The dispute was over Anthem's attempt to separate its patients from their trusted healthcare providers. A Fulton County Superior Court judge extended an injunction that allowed 400,000 Northside patients with Anthem insurance to remain in-network with the hospital. The dispute was eventually settled, with a new contract giving Anthem members in-network access to Northside hospitals, physicians, and outpatient locations in Georgia.
| Characteristics | Values |
|---|---|
| Number of Northside patients with Anthem insurance | 400,000 |
| Location of Northside Hospital | Atlanta, Georgia |
| Anthem Blue Cross's argument | Northside charged more than most metro hospitals |
| Northside's argument | Georgia bill prohibited payers from terminating a provider's in-network coverage for up to 150 days after a public health emergency |
| Judge's ruling | The dispute should be settled by the Georgia Department of Insurance |
| Judge's ruling extension date | June 15 |
| Date of the new contract | July 12 |
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What You'll Learn
- A Fulton County Superior Court Judge extended an injunction to ensure healthcare coverage for Anthem patients
- Anthem Blue Cross Blue Shield wanted to change its contract, alleging Northside charged more than most metro hospitals
- Northside argued that a Georgia bill prohibited payers from terminating a provider's in-network coverage during a public health emergency
- A judge ruled that the Northside-Anthem matter should be referred to the Georgia Department of Insurance
- The new contract gives Anthem members in-network access to Northside hospitals, physicians, and outpatient locations
A Fulton County Superior Court Judge extended an injunction to ensure healthcare coverage for Anthem patients
In April 2022, Fulton County Superior Court Judge Rachelle Carnesale extended an injunction to ensure that around 400,000 Anthem patients could continue to access Northside Hospital facilities and physicians. The injunction, which had previously been set to expire on April 15, was extended indefinitely, or "until further order". This means that Anthem patients will remain in-network with Northside Hospital.
The dispute between Anthem Blue Cross Blue Shield insurance and Northside Hospital began in late 2021 when Anthem started the process of ending coverage of Northside Hospital physicians and facilities. Anthem alerted consumers that Northside may not be part of its network by January 1, 2022. Northside argued that Georgia law prevents insurers from ending coverage during a public health emergency such as COVID-19.
In her ruling, Judge Carnesale agreed with Anthem's argument that the Georgia Department of Insurance, rather than the courts, should settle the dispute. She set a deadline of June 15 for Northside and Anthem to provide an update on the status of the Department of Insurance's review.
Following the ruling, an Anthem spokesperson said that the company had been working to reach a new agreement with Northside to "provide affordability, greater quality, and promote health equity". They added that they had been engaged in regular discussions with Northside and were working towards finalizing an agreement in the best interests of consumers.
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Anthem Blue Cross Blue Shield wanted to change its contract, alleging Northside charged more than most metro hospitals
In 2021, Anthem Blue Cross Blue Shield notified Northside Hospital that it wanted to change its contract, citing that Northside charged more than most metro hospitals. This sparked a legal dispute between the two parties, with Northside arguing that the contract was not up for renewal and that a Georgia bill signed during the pandemic prohibited payers from terminating a provider's in-network coverage within 150 days after a public health emergency.
The dispute affected around 400,000 Northside patients with Anthem insurance who were at risk of losing their in-network coverage. To maintain the status quo for these patients, a Fulton County Superior Court Judge, Rachelle L. Carnesale, extended an injunction, requiring Anthem and Northside to take their dispute to the Georgia Department of Insurance for resolution.
During the legal battle, Cherokee County joined the process, arguing that a significant portion of its residents and employees relied on Anthem insurance and that the dispute could imperil their lives amid the COVID-19 pandemic. A psychiatrist also raised concerns about Anthem's potential monopoly on healthcare in metro Atlanta and its impact on minority access.
Despite the ongoing legal proceedings, Anthem and Northside Hospital ultimately agreed to a new contract, providing Anthem members with continued in-network access to Northside's healthcare services in Georgia. The resolution ensured that patients with Anthem insurance could continue receiving quality care at Northside Hospital without disruption.
The new agreement between Anthem Blue Cross Blue Shield and Northside Hospital demonstrates the importance of collaboration and compromise in ensuring stable and accessible healthcare services for the community. By working together, the two parties were able to enhance their partnership and maintain uninterrupted access to healthcare for thousands of Georgians.
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Northside argued that a Georgia bill prohibited payers from terminating a provider's in-network coverage during a public health emergency
Northside Hospital and Anthem Blue Cross and Blue Shield in Georgia have settled on a new contract after a dispute that included a hearing before the Georgia Supreme Court. The dispute arose when Anthem notified Northside that it wanted to change its contract, alleging that Northside charged more than most metro hospitals. Northside disagreed, arguing that the contract was not up for renewal and that a Georgia bill signed into law during the COVID-19 pandemic prohibited payers from terminating a provider's in-network coverage for up to 150 days after a public health emergency. This law is likely Georgia's "Surprise Billing" Law, which imposes new restrictions on healthcare providers and facilities to stop "surprise" billing to patients who receive out-of-network care.
Northside Hospital's argument centered on the interpretation of this Georgia bill, which aimed to protect patients from unexpectedly high medical bills, often called "surprise" or "balance" bills. These bills typically result from specialty procedures like emergency room or trauma surgery performed by out-of-network specialists. The law was designed to prevent patients from being charged more than the median in-network amount paid during the 2017 calendar year by an insurer for similar services provided in the same or nearby geographic area.
Northside Hospital's interpretation of the Georgia bill was that it prohibited payers like Anthem Blue Cross and Blue Shield from terminating a provider's in-network coverage during a public health emergency, such as the COVID-19 pandemic. This interpretation was crucial to ensuring that Northside's patients with Anthem insurance could continue accessing in-network healthcare services without incurring additional costs.
The dispute between Northside Hospital and Anthem Blue Cross and Blue Shield was eventually resolved through negotiations, resulting in a new contract that provided Anthem members with continued in-network access to Northside's hospitals, physicians, and other outpatient locations in Georgia. This resolution ensured that the approximately 400,000 Northside patients with Anthem insurance could maintain their healthcare coverage and access to Northside's services without disruption.
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A judge ruled that the Northside-Anthem matter should be referred to the Georgia Department of Insurance
The dispute between Northside Hospital and Anthem Blue Cross Blue Shield insurance centred around Anthem's attempt to change its contract with Northside, alleging that Northside charged more than most metro hospitals. Northside Hospital argued that a Georgia bill signed into law during the pandemic prohibited payers from terminating a provider's in-network coverage for up to 150 days after a public health emergency. This dispute affected around 400,000 Northside patients with Anthem insurance.
Fulton County Superior Court Judge Rachelle L. Carnesale extended an injunction that maintained the status quo for those patients until further order. Judge Carnesale also ruled that the Northside-Anthem matter should be referred to the Georgia Department of Insurance to determine if Anthem's attempt to separate patients from their trusted healthcare providers was permissible. This ruling was based on Anthem's argument that the Department of Insurance had exclusive jurisdiction over Northside's and Cherokee County's claims.
As a result of this ruling, Northside Hospital and Anthem Blue Cross Blue Shield of Georgia have agreed to a new contract, providing Anthem members with in-network access to Northside's hospitals, physicians, and other outpatient locations in Georgia. This new contract ensures continued access to quality healthcare for Georgians, which is the focus of both Northside Hospital and Anthem Blue Cross Blue Shield.
The resolution of this dispute through the Georgia Department of Insurance demonstrates the importance of having a body that can settle disagreements between healthcare providers and insurance companies. By ruling that the Northside-Anthem matter should be referred to the Georgia Department of Insurance, Judge Carnesale helped protect the rights of hundreds of thousands of Georgians and ensured that they could continue to receive the medical care they need without disruption.
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The new contract gives Anthem members in-network access to Northside hospitals, physicians, and outpatient locations
Northside Hospital and Anthem Blue Cross and Blue Shield in Georgia have agreed to a new contract after a dispute that included a hearing before the Georgia Supreme Court. The new contract gives Anthem members in-network access to Northside hospitals, physicians, and outpatient locations. This is a significant development for the approximately 400,000 Northside patients with Anthem insurance who were previously caught in the middle of the dispute between the two parties.
The previous dispute between Northside Hospital and Anthem centred around allegations by Anthem that Northside was charging more than most metro hospitals. Anthem sought to end their contract with Northside, but Northside argued that the contract was not up for renewal and that a Georgia bill signed into law during the pandemic prohibited payers from terminating a provider's in-network coverage for up to 150 days after a public health emergency.
The new contract takes effect immediately and will remain in place "for the foreseeable future," according to a joint news release by Northside Hospital and Anthem. This means that Anthem members can continue to receive healthcare services at any Northside location or physician practice on an in-network basis. The contract also covers other outpatient locations in Georgia.
This resolution is a positive outcome for both parties and, most importantly, for the patients who rely on their partnership for healthcare services. Anthem Blue Cross and Blue Shield in Georgia President Robert Bunch expressed satisfaction with the resolution, stating that the "new agreement with Northside continues and enhances our partnership, continuing access to quality care for Georgians, which is our focus."
The contract between Northside Hospital and Anthem Blue Cross and Blue Shield in Georgia has been a source of contention for some time, with Northside Hospital citing a Georgia law that prohibits insurers from terminating providers from their networks during a public health emergency. With the new contract in place, patients can rest assured that they will continue to have access to the healthcare services they need without disruption.
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Frequently asked questions
Yes, Northside Hospital and Anthem Blue Cross and Blue Shield in Georgia have agreed to a new contract after a dispute that included a hearing before the Georgia Supreme Court.
The dispute arose when Anthem notified Northside it wanted to change its contract, alleging Northside charged more than most metro hospitals. Northside argued that the contract was not up for renewal and that a Georgia bill signed during the pandemic prohibited payers from terminating a provider's in-network coverage.
The new contract, effective immediately, will give Anthem members in-network access to Northside's hospitals, physicians, and other outpatient locations in Georgia for the foreseeable future.
About 400,000 Northside patients have Anthem insurance.
