Judge intervenes to keep Anthem Blue Cross from immediately canceling hospital contracts

Lawyers for Northside Hospital won a crucial victory with a ruling blocking Anthem Blue Cross Blue Shield from canceling contracts for in-network insurance coverage.

Fulton County Superior Court Judge Rachelle Carnesale heard arguments Wednesday and issued orders late Friday extending temporary injunction orders issued a month ago that would have expired Monday. The orders prevent the insurance company from terminating contracts with Northside’s five hospitals and all its medical practice groups until at least April 15. The judge also denied the insurance company’s motion to dissolve the injunction and request to remove the dispute to private arbitration.

“We are thrilled that the court ruled in Northside’s favor in every respect and preserved Northside’s patients’ access to world-class care while Northside and Anthem continue to negotiate their agreements,” said Robert Highsmith of Holland & Knight. He is working on the matter with S. Derek Bauer of Baker & Hostetler.

The dispute centers on agreements that have been in effect for as long as 20 years between Atlanta’s Northside Hospital and its affiliated physician groups—including the largest primary care, cancer treatment and gastroenterology practices in the state—with Anthem Blue Cross Blue Shield, the largest medical insurance provider in the state. Those affected include state employees and teachers. Several school systems wrote letters of concern to the court—and two suburban governments—Cherokee and Gwinnett counties—filed motions to intervene as plaintiffs. The judge granted Cherokee’s motion, allowing it to represent the interests of the others.

“Northside’s agreements with Anthem were not up for renewal and were not set to expire. Still, Anthem began a process that would separate hundreds of thousands of Georgians from their doctors and health care resources by unilaterally and without cause terminating the existing agreements,” the hospital said in a written statement. “This most recent 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 through April 15.”

The new deadline allows the parties time to negotiate terms for new contracts. Anthem alleged that Northside is one of the most expensive health care systems in the state and that the agreements are no longer affordable. Jim Hollis of Balch & Bingham represents the company. For this latest hearing, he added litigators from Troutman Pepper that include James Washburn and former Georgia Supreme Court Chief Justice Harold Melton, who retired from the bench last year.

“Our intention remains the same as it was 10 months ago when we began negotiations—to work in good faith to reach a new, consumer friendly agreement with Northside,” Anthem said in a written statement. “We have given Northside a fair and reasonable proposal with generous increases, which are more than enough to keep them in our care provider network. It’s important we work together to finalize a new agreement that works to increase accessibility by protecting affordability and ensuring quality.”

More than a dozen lawyers presented complex arguments for both sides. But the key to the decision was a new law passed by the General Assembly and signed by Georgia Gov. Brian Kemp in 2021 saying 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.”

The hospital argued the law prevents the insurance company from ending coverage; the insurance company argued the law does not apply because Kemp ended his COVID-19 public health emergency order last year.

Both judges agreed with the hospital and ruled that the COVID-19 is a public health emergency, whether Kemp recognizes it or not, and that the new law does not depend upon any declaration from a governor.