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WellStar Health System

An agreement made Wednesday between the Georgia Department of Insurance and Blue Cross Blue Shield Healthcare Plan of Georgia, also known as Anthem Blue, will have the health insurer extend benefits to cover some WellStar Health Systems services for the remainder of the year.

Under the agreement, Anthem Blue will extend benefits to Impacted Pathway Members — those individuals who enrolled in Pathway plans offered by Anthem Blue on the Federal Health Insurance Exchange or on anthem.com during the open enrollment period for 2019 and who selected or were assigned to a primary care physician affiliated with WellStar Health.

The extended benefits will allow those individuals to receive treatment from WellStar Health primary care physicians and specialists between Feb. 4 and Dec. 31, 2019. The benefit extension will not apply to outpatient services or hospital inpatient admissions at WellStar Health Hospitals occurring after Feb. 4.

Wednesday’s action was the latest episode in the conflict between WellStar and Anthem.

In August, Anthem notified WellStar that in early February 2019, it would be dropping WellStar as a provider for its Pathways plan, which Anthem sells on the Affordable Care Act marketplace, according to court documents.

However, a class action suit filed in February alleges several people who signed up for the Pathways plan during open enrollment late last year did so because Anthem advertised that WellStar would be considered in-network.

Last month, Insurance Commissioner Jim Beck scheduled a May 29 hearing, later rescheduled for June 12, at which Anthem was to be asked to give reasons why his office shouldn’t take action against them for alleged violations of state law related to the health insurance company dropping WellStar as a provider. Beck’s order setting that hearing said “it appears that Anthem Blue has been engaged in or is engaging in an unfair method of competition or an unfair or deceptive act of practice in the business of insurance.”

That hearing, however, will not take place following Wednesday’s agreement, which, according to Beck’s office is “an effort to obtain an adequate remedy for impacted Georgia consumers.”

“Consumers should work with their insurer and doctors to ensure that they get the proper medical care and insurance coverage,” the state office wrote in Wednesday’s news release. It also said the department’s Consumer Services Division would be available to assist consumers with questions about how they may benefit from Wednesday’s order by calling 404-656-2070.

Follow Jon Gargis on Twitter at https://twitter.com/JonGargis.


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