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Anthem Working to Make Northside Hospital System More Affordable for Georgians

December 31, 2021
 
 
Update: April 13, 2022
 
The current Northside Hospital System (“Northside”) contract with Anthem Blue Cross and Blue Shield (“Anthem”) has been extended beyond April 15, 2022. This means Northside physicians and hospitals will remain in Anthem’s network until further notice by the court.
 
It’s important to note that we do not yet have a new agreement with Northside and we are continuing to work toward that goal. 

It has been almost a year since we initiated good faith negotiations in an effort to come to terms on a new, consumer-friendly agreement with Northside. We cannot continue down the path that has allowed Northside to become one of the most expensive care providers in the metro-Atlanta area, and one of the more expensive hospital systems in the country. That’s why we remain committed to reaching a new agreement with Northside – one that protects affordability, works to ensure quality for our members and fosters health equity.

We understand many of our consumers have relied on Northside facilities and physicians for their healthcare needs, and it is still our intent to reach a new agreement that would keep Northside in our network. However, our good-faith efforts have been met with Northside's resistance and legal maneuvering. We now ask Northside to join us in bringing to an end this year-long negotiation and finalizing an agreement that is in the best interests of consumers.
 
Members can stay up to date on our talks with Northside by returning to this site at anthem.com/Northside or by calling us at the Member Services number on their Anthem ID card.

Frequently Asked Questions
 
Q: Why would Anthem try to drop Northside from its network when people need access to emergency care with COVID and other illnesses?
 
A:  Our members can rest assured knowing that we cover emergency care, including COVID-19 related care, at any provider - whether, that provider chooses to be in our network or not. We cover COVID-19 and emergency services based on the member’s benefit plan. Northside Hospital System facilities are required to provide emergency care to members, including those who may have COVID-19.

We do encourage members to make informed choices about when to use emergency room care. In-network urgent care centers are appropriate when a member needs care for a condition that is non-life threatening, or does not pose a risk of serious injury, impairment or dysfunction.
 
 
Q: What happens if a member is in ongoing treatment if/when Northside goes out of network?
 
A: A member’s benefits may continue to cover their care with Northside for a limited time if they are:
  • In an active course of treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment in order to avoid death or permanent harm. It may also be an ongoing (chronic) illness that is live threatening or potentially disabling and requires specialized care over a long period of time.
  • Scheduled for nonelective surgery by your current doctor, including your post-op care for the surgery.
  • Pregnant – regardless of trimester.
  • Terminally ill.
When we approve a member for continuity of care, the member’s benefits may cover the claims as if the hospital is in their plan’s network. The member may only pay their deductible, copay, or percentage of the cost. If a member has a condition that qualifies for continuity of care, but we don’t approve their request (for example, if they didn’t start a course of treatment with Northside before the contract ended), we won’t provide continuity of care benefits. Depending on their plan’s benefits, the member’s cost may be significantly higher because the hospital is not in their plan’s network.
 
Q: Why can’t Anthem and Northside put their differences aside and just get a deal done?
 
A: We have given Northside a proposal with generous increases – one they could sign immediately – yet they have refused. Northside wishes to continue operating under a contract that will not achieve the affordability or quality improvements we have been seeking, and our members deserve. We’d like Northside to join us in focusing solely on reaching an agreement that is in the best interests of consumers.
 
Q: Which facilities do these negotiations affect?
 
A: Northside Hospital Atlanta
Northside Hospital Forsyth
Northside Hospital Cherokee
Northside Hospital Gwinnett
Northside Hospital Duluth
Northside Surgery Centers
Northside Imaging Centers
Northside Urgent Care Locations

Q: Would Northside Hospital System doctor groups also be affected?

A: Yes. Doctor groups are affected by these negotiations. Some physicians may remain in our networks (if they are also contracted with us outside of Northside), so members are encouraged to check Provider Finder or call the Member Services team to confirm.
 
Q: Which plans do these negotiations affect?
 
A: The negotiations affect all of the following self-funded and fully insured group, individual and Medicare Advantage plans:
 
  • Point of Service (POS), Preferred Provider Organization (PPO) and Medicare Advantage Networks: If Northside is no longer in our plans’ network, members would pay more if they receive non-emergency care from Northside facilities or doctors. Members’ costs are lower if they choose doctors and facilities in their plan’s network. This is because the plan pays more of the costs and healthcare professionals if the plan has agreed to accept lower, negotiated rates. Doctors and facilities that aren’t in the plan’s network can bill members the difference between what Anthem pays for the claim and what they charge.
     
  • Health Maintenance Organization (HMO), Individual Pathway Plans and Blue High Performance Network Exclusive Provider Organization (EPO): If Northside is no longer in our plans’ network, members would need to choose another hospital or doctor in their plan’s network for non-emergency care. Members who receive care from doctors and facilities not in their plan’s network are responsible for the total amount billed for the care.
Q. What other Anthem network hospitals in the area can members use?
 
A: Members can continue to use Northside Hospital System as the negotiations continue.
 
Members can also call Member Services to check if their doctor has admitting privileges at another nearby hospital in their plan’s network. Members should confirm this with their doctor. We will help members understand their choices and how their costs may increase if they choose a doctor or facility that is not in their plan’s network.
 
Also, Anthem has a broad, statewide plan network. Members can find doctors, specialists, and hospitals in their plan’s network on the Sydney HealthSMl mobile app or by logging in to anthem.com. Members should check with the new doctor or facility to make sure they are in the plan’s network.
 
Q: How can I find a new doctor or facility in the plan’s network if Anthem and Northside Hospital System don’t reach agreement?
 
A: Anthem offers a broad network of doctors, healthcare facilities, and other healthcare professionals. Use the Find Care tool on the Sydney Health mobile app or by logging in to anthem.com to find doctors, specialists, and hospitals in your plan’s network. Check with the new doctor or facility to make sure they are in your plan’s network.
 
Q: What are Anthem and Northside and negotiating?
 
A: Anthem is in discussions with Northside Hospital System over contractual language and rates that directly affect members’ healthcare costs. Contract reviews are a standard, routine part of what we do. Our goal is to reach an agreement that gives our members access to high-quality, affordable care, while ensuring that we pay doctors, hospitals, and other healthcare professionals fairly.
 
Q: What are the core issues Anthem and Northside are discussing?
 
A: Our priority is protecting our members’ access to high-quality, affordable healthcare. Our members and their employers often pay for any healthcare cost increases. Many employers are self-insured and pay for employees’ medical care directly.
 
Certain hospital practices contribute substantial and unnecessary cost to the healthcare delivery system: Specialty drug pricing, billing practices, site of care, and mergers and acquisitions can all have significant impact on the overall cost our members pay for healthcare, as well as on our ability to offer flexible plan networks and innovative, cost-effective benefit designs.

We are actively negotiating in good faith and hope to reach a new agreement that keeps Northside in our network.

The rising cost of healthcare
Providing access to affordable healthcare is more difficult than ever as hospital costs continue to rise. Consider these statistics:
  • Data from the 2020 RAND report shows that hospital prices in Georgia have continued to trend upward. RAND also sites Northside as the second most expensive system in Georgia, and the 33rd most expensive in the U.S. (2020 Rand Report: rand.org)
  • According to the Centers for Medicare and Medicaid Services, hospital spending grew 6.2% in 2019, reaching nearly $1.2 trillion. By 2026, the Center for American Progress says that $1 of every $5 spent in the American economy will go toward healthcare.
Quality affordability
 
  • Georgia ranked No. 46 among the states in the 2020 Commonweath Fund report on health system performance. The scorecard rates access, quality, costs of care, health outcomes and income-based health disparities.