Frequently Asked Questions
Contract negotiations between insurance companies and providers are very common. It’s critical that we have collaborative partnerships with health insurance companies like United. Stability, predictability and fair compensation from United is necessary for us to continue to provide high-quality care for our patients.
NGHS will always care for patients with United insurance in our hospitals’ Emergency Departments, regardless of whether they are in or out of network. We will continue to provide care for our Medicare Advantage patients who have the option to use an out-of-network provider.
We are trying to help patients whose care through NGHS is considered out-of-network find the nearest appropriate in-network provider. You may need to request your medical records at nghs.com/medical-records. There are options to access the records online, through MyChart, in person at our Corporate Plaza location, or by phone or fax.
United has a history of using its size as the largest insurer in the nation to push harmful contracts and policies on health systems across the country. In fact, they recently forced Mt. Sinai hospitals in New York, Prisma Health hospitals in South Carolina and Baptist Health in Kentucky out of network as well.
It is frustrating to see United use patients as a bargaining chip in their attempt to increase profits – totaling nearly $90 billion for United’s most recently reported year – which go to shareholders instead of new facilities, equipment and services you need right here at home. Every other insurance company has agreed to the same requests, but United has many unacceptable demands like:
Refusing to cover care at all NGHS locations – even new ones – the same way. Patients deserve to know that any time they visit an NGHS location, their care will be covered. For example, United currently refuses to allow the future NGMC Lumpkin hospital to be covered the same way the other NGMC campuses are covered.
Denying coverage for patients in our hospitals, even if United approved the care initially. Patients deserve to know that United won’t withdraw their approval after care has begun. United wants the ability to deny coverage for hospital care in the days or weeks after they approved admission.
We have been negotiating with UnitedHealthcare regarding a new contract that covers the care we provide to their members with commercial health insurance plans. Negotiations are a normal part of business regarding contracts between health insurers and health systems, and they ensure we have the terms and resources necessary to continue providing affordable and quality care for our community in a sustainable way.
Contract negotiations between insurance companies and providers are very common. It’s critical that we have collaborative partnerships with health insurance companies like UnitedHealthcare. Stability, predictability and fair compensation from UnitedHealthcare is necessary for us to continue providing high-quality care for our patients. Every other payor we are contracted with recognizes the value we bring to their members and compensates us appropriately for that care. Our goal is to have UnitedHealthcare leadership recognize the vital role we play in the health of northeast Georgia.
The contract with UnitedHealthcare expired on April 30, 2023.
UnitedHealthcare commercial members may have to pay higher out-of-pocket costs for care with our physicians or at our hospitals and facilities. United may direct you to change your healthcare providers.
Only UnitedHealthcare commercial (employer-sponsored) health plans are impacted by the negotiations.
No. Members of UnitedHealthcare Medicare Advantage plans and Health Insurance Exchange plans will not be affected.
All facilities within Northeast Georgia Health System are impacted:
- All Northeast Georgia Medical Center hospitals
- All Northeast Georgia Physicians Group practices
- All Urgent Care locations
- All Georgia Heart Institute locations
- All practices under management of NGPG
- All outpatient facilities, including:
- Imaging Center
- Cancer Center
- Rehabilitation Institute
- New Horizons of Limestone and Lanier Park
- Laurelwood
All Northeast Georgia Physicians Group and Georgia Heart Institute physicians are impacted by the negotiations. We recommend you call your physician directly if you are unsure if they are impacted by our negotiations.
New legislation in Georgia (HB454) could provide some patients coverage as if they were in-network until October 27. To find out if you’re covered by this law, contact your benefits coordinator and ask if your health benefit plan is a “fully-insured” plan or is a “self-funded” plan.
- If your health benefit plan is “fully insured,” it is subject to the new Georgia legislation (HB454). HB454 requires UnitedHealthcare to pay for pre-approved care at NGHS at in-network rates for 180 days after the beginning of an out-of-network period if NGHS was listed in the UnitedHealthcare online provider directory during your last open enrollment period. In this case, in-network coverage for pre-approved care will last until October 27.
- If your health plan is a “self-funded” plan, HB454 does not apply.
For non-emergency care: UnitedHealthcare may limit your access or increase your out-of-pocket costs to continue care at our hospitals and facilities and with our physicians.
For emergency care: If you have a medical emergency, always go to the nearest emergency room. Patients needing emergency care are entitled to receive in-network treatment until the patient is stable. Once the patient is stable, they have the choice to either continue care with NGHS or be transferred to a facility that is in-network with their health insurance plan.
If you are already admitted to the hospital prior to April 30, 2023, you will be covered at in-network rates through the end of your inpatient stay.
Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment prior to the contract end date may qualify for Continuity of Care through UnitedHealthcare. Download a Continuity of Care form and apply.
Continuity of Care Information
If you have a medical emergency, always go to the nearest emergency room. Patients needing emergency care are entitled to receive in-network treatment until the patient is stable. Once the patient is stable, they have the choice to either continue care with NGHS or be transferred to a facility that is in-network with their health insurance plan.
For a complete list of the insurance plans currently accepted at NGHS facilities, visit www.nghs.com/insurance.
We will continue to keep our patients informed as negotiations progress. For the most up-to-date information, check back here or call 470-892-3514.