Health

Anthem, Amid Dispute With WellStar, Gives Exchange Patients A (Temporary) Break

The contract for exchange coverage between Anthem and Marietta-based WellStar ended Monday. But instead of making WellStar exchange patients out of network immediately, Anthem said it would allow another 90 days of network coverage for those members who selected, were assigned or tried to choose a WellStar-affiliated primary care physician.
The contract for exchange coverage between Anthem and Marietta-based WellStar ended Monday. But instead of making WellStar exchange patients out of network immediately, Anthem said it would allow another 90 days of network coverage for those members who selected, were assigned or tried to choose a WellStar-affiliated primary care physician.
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Anthem Blue Cross and Blue Shield has given people in the Georgia insurance exchange more time to visit WellStar Health System doctors and presumably not face higher out-of-pocket costs.

The contract for exchange coverage between Anthem and Marietta-based WellStar ended Monday. But instead of making WellStar exchange patients out of network immediately, Anthem said it would allow another 90 days of network coverage for those members who selected, were assigned or tried to choose a WellStar-affiliated primary care physician.

The contract dispute affects thousands of Georgians, many of them in the northwest Atlanta suburbs.

Separately, Anthem’s Georgia operation has been hit with layoffs. It’s believed that roughly 50 employees have lost jobs in the state. Anthem would not comment on the number of layoffs, while confirming that jobs have been cut in other markets as well.

Anthem, in a statement late Monday, acknowledged that some Georgia consumers “may have enrolled in Anthem plans based on the incorrect assumption WellStar would remain in our Pathway network throughout 2019.’’

The Indianapolis-based company said it has worked closely with Georgia Insurance Commissioner Jim Beck to extend WellStar coverage beyond Monday.

Pathway members can receive treatment from WellStar primary care doctors until May 4, and Anthem will allow the previously contracted reimbursement rate for physicians, the company said in a statement. It added, however, that it “cannot guarantee WellStar will permit Pathway members to schedule appointments, or will not bill members for the difference between the Anthem allowed reimbursement and WellStar’s billed charges.’’

WellStar officials could not be reached for comment late Monday about the extended coverage period.

Consumers have complained that when they signed up for Anthem exchange coverage late last year, WellStar was listed as part of the insurer’s network.

Although formal notices of contract termination are frequently part of the negotiation dance, enrollees are increasingly skittish about disruptions to their health care.”

Chris Kane, a consultant for Progressive Healthcare, on how contract disruptions leave consumers in the middle

Insurance exchanges, created by the Affordable Care Act, help people find and buy health coverage if they are not insured by private employers or the government. WellStar patients who got Blue Cross exchange plans are the ones affected by the contract dispute.

The dispute does not affect WellStar patients who have employer-provided or individual Medicare Advantage health care through Anthem.

The biggest area of impact of the contract termination is in Cobb County and other northwest Atlanta suburbs, where WellStar dominates the health care market. WellStar has 11 hospitals, several of them in those suburbs.

“We look forward to ensuring our members receive high-quality, affordable care through our network of participating providers and hospitals,” Anthem said. “Consumers with questions can call the number on the back of their Anthem ID card or go to anthem.com/wellstar.

Chris Kane, a consultant for Progressive Healthcare, said recently that such contract disruptions leave consumers in the middle.

“In recent years, Anthem/Blue Cross has engaged in high-profile negotiations with Grady and Piedmont,’’ Kane said. “Although formal notices of contract termination are frequently part of the negotiation dance, enrollees are increasingly skittish about disruptions to their health care.”

For patients, especially those with a chronic disease, ”changing physicians is frustrating and time-consuming,” he added.

Mike Harbert, 64, a real estate agent in the Cobb County city of Mableton, has pre-existing conditions. He has had the same primary care physician, one affiliated with WellStar, for 28 years. He says he was misled in signing up for Anthem because he checked to see whether WellStar was in its network and found that it was.

Harbert said Monday, before the time extension was announced, that he had signed up for a new primary care doctor. “It wasn’t easy to find one in network,” he told GHN.

Anthem said the layoffs in Georgia were part of a national corporate action.

“Health care is continuously changing and evolving,’’ Anthem spokesman Colin Manning said in a statement Monday. “At Anthem, our business strategy — together with our organizational structure and culture — is the foundation for our continued success. As a result, Anthem must evolve to reflect the changing needs of our consumers, our markets and our industry.

“These adjustments are part of the normal course of business as health care, and Anthem, adapts and changes.”

Andy Miller is editor and CEO of Georgia Health News