UPDATE: Northside Hospital granted injunctive relief stopping termination of health coverage | Investigations

UPDATE (CBS46) — Northside Hospital has been granted injunctive relief by the court that temporarily stops a threatened termination of health care coverage by Anthem Blue Cross Blue Shield, according to a press release.

The decision by the Superior Court of Fulton County enables Anthem members who seek care at Northside’s hospitals, clinics, and physician practices to remain fully covered and in-network while the parties work towards a long-term resolution.

In its court filings, Northside cited a Georgia law that went into effect July 1, 2021. House Bill 454 was approved by both houses of the Georgia General Assembly and signed by Gov. Brian Kemp. Specifically, the law states in part:

“In the event of a public health emergency…..an insurer shall, for a period commencing on the effective date of the public health emergency and ending 150 days after the expiration of such public health emergency…..be prohibited from terminating a provider from the insurer’s network…..”

Anthem members can continue to receive health care services at any Northside location or physician practice on an in-network basis after Jan. 1. The injunction issued by the courts is a temporary measure to ensure Anthem patients can still access care within the Northside Healthcare System. In the meantime, Northside will continue its discussions with Anthem, with the intention of reaching a long-term agreement that provides the best benefits to patients and their families. 

Anthem released the following statement: 

Original story below

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CUMMING, Ga. (CBS46) — The deadline for Northside Hospital System and Anthem Blue Cross Blue Shield to come to an agreement on healthcare and insurance coverage is Dec. 31.

If the two don’t agree, 400,000 Georgians will be forced to find new doctors or pay more for healthcare, starting Jan. 1.

That includes Tonya Lang of Cumming, and her 10-year-old son, Mason. CBS46 first introduced you to them last month.

“I like Star Wars, I like Mickey,” Mason said.

Mason is just an ordinary kid with an extraordinary condition. He was born with a congenital heart defect called ‘Hypoplastic Left Heart Syndrome’ or HLHS. Essentially, he has half a heart.

“I don’t really see it as a big deal,” Mason said.

“Mason has a severely small left ventricle that would not sustain life for him, so he’s had to have a series of heart surgeries,” Lang said.

The 10-year-old relies on the doctors at Northside Forsyth.

That’s why his mom, Tonya, was outraged when she found out her insurance company, Anthem Blue Cross Blue Shield, and her hospital system, Northside, couldn’t see eye to eye.

She hoped they would come to an agreement but as the deadline inches closer, not much has changed.

“I still haven’t heard whether or not they’ve come to an agreement,” Lang said. “It’s frustrating. It’s concerning.”

That’s because the negotiations are still ongoing.

Tina Gaines, a spokesperson for Anthem, told CBS46 Investigates on Thursday: “Since negotiations began seven months ago, it has been our intent to reach a new agreement that would keep Northside in your (our) health plans and avoid this very situation.

With the termination deadline looming, we are disappointed with Northside’s lack of urgency to resolve key issues that impact our employer-sponsored plans – the current contract doesn’t adequately align incentives to improve quality and affordability for our members.

We understand this causes uncertainty for many of our consumers who have relied on Northside facilities and physicians for their healthcare needs, which is why we’re going to continue our discussions with Northside officials because we want to keep them in our members’ health plans.”

Meanwhile, Lee Echols, vice president of Northside, told CBS46 Investigates: “Northside Hospital has enjoyed a successful partnership with Anthem Blue Cross Blue Shield for more than 30 years. Despite this long-standing relationship, Anthem notified us of its intent to terminate their agreements with the entire Northside Hospital System, effective December 31, 2021. This decision surprised Northside – our agreements with Anthem were not up for renewal and were not set to expire. Nearly 400,000 Northside patients could be affected by this unplanned termination. Anthem’s threat also is muddying the open enrollment period, as patients are deciding on health care coverage for their families for the coming year. Northside has called tens of thousands of patients, making them aware of Anthem’s intentions and providing guidance in their decision-making.”

“It’s very frustrating that it comes down to dollars and cents. They seem to think that we have prices attached to us,” Lang added.

Tonya and Mason Lang are among 400,000 Georgians who will be impacted by these negotiations.

Some Forsyth County residents took to Facebook to voice their concerns like Ritesh G. who decided to switch carriers, posting, “can’t bet my life on those negotiations.”

And Celeste R. who said, “switching just to be safe.”

As for Tonya, because she says Mason’s life is quite literally on the line, she’s sticking with the doctors at Northside Forsyth, even if it means paying more out of pocket.

“We’ll just have to figure out how to juggle those bills as they come in,” Lang said.

Liz Coyle, who heads consumer advocacy agency, Georgia Watch, said we’re seeing contract disputes like this nationwide. And she blames it on two things:

1) Consolidation of the marketplace. That’s when we see mergers involving two major companies that provide similar services like anthem and blue cross blue shield.

2) Inadequate network standards. That’s when your insurance plan doesn’t give you enough access to trusted providers in your area.

“We’ve yet to see costs go down for consumers when hospitals merge. What happens when there’s less competitions always happens: prices go up,” Coyle said.

Coyle goes as far as saying that just like surprise billing, this is the next big issue in the healthcare debate and the only way to fix it is the same way we fixed that: through legislation.

“Something like that needs to happen in this case,” Coyle said. “That disagreement should not leave 400,000 without access to a trusted provider or having to travel long distance to get in-network care.”