Anthem contract dispute in Georgia rages on
Anthem has been trying to end its deal with Northside since the end of 2021, a move that would cancel in-network coverage for policyholders.
Lawyers for Northside Hospital and its medical care providers are still locked in litigation with Blue Cross Blue Shield of Georgia, owned by Anthem insurance company—but now they’ll have to move to a new venue.
Fulton County Superior Court Judge Rachelle Carnesale has issued a new order in the contract dispute between Georgia’s largest health insurance provider and one of metro Atlanta’s biggest hospital and physician groups. She extended indefinitely the preliminary injunction preventing the insurance company from terminating contracts with Northside’s five hospitals and associated practices. Anthem has been trying to end its deal with Northside since the end of 2021, a move that would cancel in-network coverage for policyholders—including state employees.
Related: Stuck in the middle: Consumers harmed by contract disputes between providers, insurers
This time, Carnesale referred the dispute to the Georgia Department of Insurance. And she stayed discovery in the lawsuit pending a declaratory judgment on the applicable insurance law.
The judge noted that Northside’s breach-of-contract claims center around the meaning of “public health emergency” in a new law passed by the General Assembly to respond to the COVID-19 pandemic.
“O.C.G.A. § 33-20C-2(g)(2), effective July 1, 2021, provides: In the event of a public health emergency, including but not limited to a public health emergency as defined in Code Section 31-12-1.1, 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: (A) Be prohibited from terminating a provider from the insurer’s network; and (B) Reimburse a provider at its most recent contracted in-network rates,” Carnesale said in an order signed Wednesday.
Anthem’s lawyers argued that the state of emergency ended when Gov. Brian Kemp said it did last year. Northside’s lawyers argued the state of emergency is ongoing and the law does not tie it to any order by a governor. The judge favored Northside by blocking Anthem from ending the contracts but now is asking the insurance department to make a definitive ruling.
Robert Highsmith of Holland & Knight represents Northside along with S. Derek Bauer of Baker & Hostetler.
Jim Hollis of Balch & Bingham represents Anthem. For this matter, he enlisted the help of Troutman Pepper litigators including James Washburn and former Georgia Supreme Court Chief Justice Harold Melton, who retired from the bench last year.
The attorneys deferred to corporate representatives, who shared written statements Thursday.
Northside noted that the ruling means Anthem patients “can continue to receive their medical care in the Northside Hospital system on an in-network basis beyond April 15,” which would have been the expiration date for the earlier temporary injunction.
“Northside has diligently pursued legal remedies in this dispute because of its critical importance to protecting the rights of hundreds of thousands of Georgians,” the hospital said. “Northside will continue to provide updates to its patients and their families as they develop.”
Anthem expressed hope of success with the underlying negotiations for new contracts. Since the beginning, the insurance company has said Northside has become too expensive, and the hospital has alleged Anthem is trying to underpay.
“Ensuring access to care is why we began negotiations early and have been working in good faith for a year to reach a new agreement with Northside, one that provides affordability, greater quality, and promotes health equity,” Anthem said. “Unfortunately, continuing to operate under the current contract will not achieve the affordability or quality improvements we have been seeking, and that our members deserve. We have been engaged in regular discussions with Northside on a new contract. We now ask Northside to join us in bringing to an end this year-long negotiation by finalizing an agreement that is in the best interests of consumers.”
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