After contract negotiations failed, most Piedmont Healthcare patients insured by Anthem Blue Cross and Blue Shield will have to pay higher out-of-pocket costs for treatment or find new doctors until a new agreement is reached.
Round-the-clock negotiations failed to bring an agreement on a new contract between Anthem Blue Cross, the state’s largest health insurer, and the rapidly expanding Piedmont system before the old contract expired March 31. Piedmont Healthcare, which operates its flagship Piedmont Hospital in Buckhead on Peachtree Road, has now been taken out of Anthem Blue Cross’ network.
Piedmont puts the overall number of Anthem Blue Cross members affected at about 500,000. Piedmont Healthcare sees about 2 million patients per year, or 20 percent of state’s population, said Kevin Brown, the president and CEO of Piedmont Healthcare, at the March 29 Buckhead Business Association meeting.
“The unfortunate part of healthcare is it’s a business,” Brown said just days before the negotiations failed. “We’re here to take care of people, and when those things collide, it’s not fun for anybody. Patients get caught in the middle.”
It’s hard to say how long the impasse will last. Gov. Nathan Deal has expressed intense concern about the potential effect on Georgia, saying that if Piedmont and Blue Cross could not reach an agreement, that would create ‘‘a major problem’’ for state employees insured by Anthem Blue Cross.
According to state officials, there are some protections available for people with ongoing medical situations. A state law allows a person with a chronic or terminal illness to have continuous coverage for up to 60 days at in-network rates after a contract lapses during that care. A woman who is pregnant can maintain in-network coverage for the entire pregnancy, and up to six weeks after childbirth, state officials say.
Brown said the contention was over requests from Anthem Blue Cross that it has unilateral control on deciding if it will pay for services and that physicians not increase their rates for three years.
“Despite our size, we’re a pimple compared to the size of Anthem and they’re used to pushing people around,” Brown said. “They carry a very big stick.”
This contract lapse affects many more patients than it would have before Brown became CEO in 2013.
Since then, the healthcare’s network has doubled, going from five to 11 hospitals. In that same time, Piedmont has increased its primary care offices from 46 to 63 and its urgent care centers from two to 21, Brown said.
“Healthcare is under a lot of pressure which is causing a lot of consolidation,” Brown said.
Neither side offered a prediction April 1 about how long it would take to get a new deal done. Typically such negotiations lead to a contract just before the old agreement expires, but it didn’t happen in this case.
“There’s no way for us to predict how this is going to evolve,’’ said Piedmont executive Matt Gove.
The standoff raised echoes of 2016, when Piedmont was out of network for almost two months for UnitedHealthcare members before the two sides agreed to a new reimbursement contract.
“This is about our patients,’’ Gove said. “We have to keep working at this. Our priority is our patients and that they continue to have access to the doctors they trust.”
Blue Cross, through spokesman Colin Manning, said in a statement Sunday that “despite our ongoing efforts, Blue Cross and Blue Shield of Georgia has been unable to reach a new agreement.”
“We apologize to our consumers for any disruption this may cause and we are working hard to reach an agreement that will bring Piedmont back into network as quickly as possible,’’ the statement said.
He encouraged patients to visit Blue Cross’ website to view a list of in-network providers in their area.
“Importantly, we want to remind our consumers that emergency care is always a covered benefit — anyone with a medical emergency should always call 911 or go to the nearest emergency department,” the statement said.
Craig Savage, a consultant with CMBC Advisors, said Sunday that more contracts such as Piedmont/Blue Cross are ending without a new deal after their renewal deadline passes. “It’s unfortunate for the patients,” Savage said.
In general, health insurers “are saying they’re being played,” he added. “But they are losing leverage. Maybe [Blue Cross] is trying to get some of its leverage back.”
Piedmont is “at risk of losing a heck of a lot of business” as the impasse drags on, Savage said. “It’s a matter of who’s going to blink first.”
He predicted the deal will get worked out. “There’s political pressure on both sides to get this done,” he said.
Piedmont has noted that the Blue Cross contract talks do not affect Blue Cross Medicare Advantage members.
The stalemate does affect all Piedmont hospitals with the exception of Piedmont Rockdale, Piedmont Columbus Regional and the newly acquired Monroe hospital, which will be called Piedmont Walton.
–This story includes reporting published by Georgia Health News.