We have a track record of transparency and have been known for decades as the health system that does the right things for the right reasons. Now, we’ll uncover the truths behind the claims UnitedHealthcare is making.
United Claims – NGHS is more expensive than other health systems.
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Our last contract negotiation with United was in 2012, and that contract has not kept pace with the economic changes we’ve all felt in the last decade.
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Currently, United pays less than any other commercial payer. NGHS is asking United for a single-digit increase to rates that puts United on a level playing field with everyone else.
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We need United to pay fairly, and you don’t want your insurance company cutting corners on your care. We believe standing up for you is just one more way we improve the health of the community in all we do.
United Claims – NGHS’s acquisition of Habersham Medical Center is bad for United’s members.
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United didn’t want NGHS to acquire Habersham Medical Center because it meant they would have to pay fairly for services. The rates that United was paying HMC did not cover the cost to provide services.
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Habersham Medical Center is now a NGMC hospital. United was paying Habersham Medical Center only a fraction of what they currently pay us for the same care.
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Rural hospitals are closing their doors across the nation because of this kind of pay practice. United claims to represent the community, but they fail to accept their responsibility for putting hospitals out of business and wiping out a community’s critical healthcare services.
United Claims – United wants to be a partner to NGHS
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In the last fiscal year, United reimbursed only 85% of what they agreed to pay in the contract. United has one of the highest claim denial rates of any other payor.
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NGHS must spend time and resources to fight to overturn inappropriate claim denials and underpayments. At one point in the year, the payment rate was only 70%. You don’t want to only receive 70% of the care you need, and we’re fighting for United to step up.
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Even when United admits their own failures to do what’s right, United takes months to resolve issues and refuses to make additional resources available to NGHS.
United Claims – UnitedHealthcare is on a journey to improve healthcare
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United’s policies that restrict access to care and eliminate payment to providers for necessary care are harmful to the health of our community.
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United wants to tell patients they must go elsewhere for care even if they and their physician want NGHS.
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During the COVID 19 pandemic, United implemented more new policies that restricted patient access to care than any other commercial payer.
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United wants the right to make policy changes between negotiations so they can increase their already high profits. United’s representatives admitted that they intend for their policy changes to have a negative financial impact on hospitals.
United Claims – NGHS is asking for too much.
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United saw a 19% increase in profits in 2022, reaching net earnings of $28.4 billion – profits that go to shareholders. These profits have continued into 2023 as they remain the most profitable company among national insurers, reporting $5.6 billion in earnings in Q1.
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NGHS reinvests all funds beyond operating expenses in projects that improve healthcare for our communities such as:
- Expanding the NGMC Gainesville campus by building a new tower, complete with a rooftop helipad so trauma patients get lifesaving care more quickly.
- A new hospital in Lumpkin County to provide both inpatient care and surgery services.
- A Medical Plaza in Buford so patients can get the care they need closer to home.
- A new Braselton Surgery Center so patients have more options for less expensive outpatient surgery.
- A Medical Plaza in Bethlehem to expand primary care and specialty services and bring Urgent Care to that community.
- A Medical Plaza and Urgent Care in Jefferson so patients don’t have to travel for care.
- A second linear accelerator for the Braselton Cancer Center so more cancer patients can have radiation therapy closer to home.
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United denies claims, doesn’t pay what they agreed to pay, changes policies and refuses to authorize care ordered by physicians.
United Claims – United is listening to NGHS’s concerns.
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On February 17, after 5 months of negotiations, United sent a completely new contract proposal – instead of revising the contract we’d been working on.
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United’s new proposal either rejected or completely ignored the chief concerns NGHS has been discussing with United’s senior leadership since May 2022. In fact, United’s new proposal pushed the parties further apart.
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United wants contract terms that restrict NGHS’s ability to make investments in new services, terms that give United the unchecked ability to write policies that are harmful to patient care, terms that create obstacles to resolving claims issues, and terms that allow United to pay less than any other commercial payer.