As Insurance Contract Disputes Continue, Some Consider Legislation
Some people buying individual coverage will have three or more insurance providers to pick from. Residents of some counties in metro Atlanta will have as many as five options.
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Piedmont Healthcare and Blue Cross Blue Shield of Georgia are still in negotiations over a new contract in a dispute that has left tens of thousands in Georgia out-of-network with Piedmont hospitals and doctors. Contract disputes between two big companies aren’t unusual, but experts say the contracts are getting tougher to negotiate.
It’s not the first time a health care system and a big insurer have had standoffs in the state. In 2014, Blue Cross Blue Shield of Georgia and Grady Hospital were initially unable to reach an agreement. In 2016, Piedmont Healthcare and UnitedHealthcare were in a contract dispute.
Bill Custer, professor of health care finance at Georgia State University, says negotiations have gotten more complex over the years as hospital systems and insurance companies have gotten bigger. There are also pressures to keep costs down.
“These kinds of pressures have been building over the last 25 years, and what we’ve seen is a consolidation on both sides,” Custer said.
Tough contract disputes have been happening in many other states. Last fall in Connecticut, there was a standoff between an insurer and a health system that lasted seven weeks.
“While it’s going on, there’s not a lot you can do,” said Ted Doolittle, the state’s health care advocate, a position that’s appointed by the governor.
Doolittle would like to see more measures that would help patients while the contract disputes are going on. A bill pending in the state Legislature there would allow patients to remain in-network for 60 or 90 days after a contract failure, he said.
“There needs to be some type of guardrails put up — not to prevent the health insurance carrier from having a contract dispute with provider – that’s fine — but to make sure that the patient isn’t harmed,” Doolittle said.
In Georgia, there are no such laws, but Gov. Nathan Deal has weighed in. The state is paying out-of-network costs for affected state employees who use the Piedmont health system, but only for up to 30 days.
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