Healthcare for thousands of patients has been thrown into limbo as Marietta-based Wellstar Health System and UnitedHealthcare failed to reach an agreement by Sunday, when the contract between the two companies ended.
The primary commercial contract’s lapse means that, in UHC’s view, Wellstar is no longer in-network for members of its employer-sponsored and individual plans, as well as the Veteran Affairs Community Care Network.
Members under the State Health Benefit Plan UHC Medicare Advantage (for Retirees) will still have in-network access, Wellstar and UHC said Monday. Medicare Advantage members were nearly at risk of losing in-network access, but that contract was extended until the end of the year. Wellstar is asking patients under that plan to change their insurance provider during open enrollment.
UHC and Wellstar also have said that those members using Medicare Advantage Group Retiree plans are still in-network — this contract was also extended to the end of the year.
For emergency room visits, UHC has said its members will be covered, saying that “our members should go to the nearest hospital and the services will be covered as in-network, regardless of the hospital’s network status.”
Wellstar said Monday that UHC members still have a form of in-network access through a secondary commercial contract that UHC has with the company MultiPlan. The hospital system said it has told UHC that its members can access Wellstar doctors and hospitals through the MultiPlan agreement, which offers “a substantial discount from Wellstar’s normal out-of-network charges,” until a new contract is brokered.
“In other words, UnitedHealthcare can access contracted rates for Wellstar physicians and hospitals on behalf of you and your family – if it chooses to do so,” Wellstar wrote on its website.
It was unclear by press time if UHC would pay the MultiPlan rates — a UHC spokesperson didn’t respond to a request for comment about the MultiPlan contract.
The two companies have engaged in a public relations war over contract negotiations, with both sides accusing the other of placing money over patients.
UHC has called Wellstar hospitals the most expensive in metro Atlanta and said the system wants to increase rates so dramatically that it would increase healthcare costs by $75 million over one year.
“Wellstar’s hospitals are already the most expensive in Atlanta, yet Wellstar refused to move off its demands for an egregious 37% price hike over three years that would have increased health care costs by more than $109 million,” UHC said Monday. “This is not sustainable or affordable for the people and employers we serve.”
Wellstar, meanwhile, has pointed out its non-profit status, cited data indicating UHC was untrusted by patients and said that UHC is choosing “profits over patients.”
“For far too long, UnitedHealthcare has been interfering in the patient/doctor relationship, increasing denials for needed services and failing to reimburse health systems like Wellstar at fair rates,” Wellstar said. “Because of the current outdated agreement, UnitedHealthcare members are unable to take full advantage of the whole Wellstar integrated network of care.”