Anthem BCBS of Georgia strikes deal to end dispute with Atlanta hospital system
After months of conflict, the deal ends uncertainty about insurance coverage for state employees, teachers and many other Georgia residents.
Georgia’s biggest medical insurance provider and one of Atlanta’s biggest hospitals said Tuesday evening they have resolved the contract dispute that has had their lawyers in court all year.
The Northside Hospital system and Anthem Blue Cross and Blue Shield in Georgia signed an agreement about 6:30 p.m., attorneys said, ending uncertainty and concern about insurance coverage for state employees, teachers and many other Georgia residents.
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The dispute has gone before two Fulton County Superior Court judges and the Georgia Department of Insurance and is now pending at the Georgia Supreme Court. Lawyers asked the high court to determine how to define a public health emergency under a new law the General Assembly passed in response to the coronavirus pandemic.
Anthem tried to cancel its in-network insurance coverage with Northside’s five campuses and many affiliated physicians groups at the end of last year, saying the reimbursement rates were among the highest in the state and no longer affordable. Northside argued Anthem was trying to underpay in a time of crisis and used the new law to block the cancellation.
S. Derek Bauer of BakerHostetler and Robert Highsmith of Holland & Knight represent Northside.
Jim Hollis of Balch & Bingham represents Anthem, along with Troutman Pepper litigators including James Washburn and former Georgia Supreme Court Chief Justice Harold Melton, who retired from the bench last year.
“The agreement reached is in the form of an amendment to the contract Anthem remains enjoined from terminating, so there should be nothing further for the parties to litigate in the courts, including the Supreme Court,” Bauer said Tuesday evening.
“While the litigation has certainly been hard fought, Northside is pleased that it was able to reach contract terms that will serve the more than one million Anthem members in metro Atlanta well for years to come and ensure their continued access to one of the finest hospital systems in the country,” Bauer said. “But Northside is most pleased that it was able to get there without a single one of those members going out of network for a single minute over the last 6½ months.”
Highsmith agreed, adding, “No one was out of network for a single minute.”
“Northside Hospital has an unwavering focus on patients and their families, and that always is our mission,” Scott Wade, vice president of Northside Hospital, said in a news release announcing the resolution. “The outcome of our discussions is great news for our partnership with Anthem Blue Cross and Blue Shield and our patients.”
Robert Bunch, president of Anthem Blue Cross and Blue Shield in Georgia, said in a joint statement with Northside, “I’m pleased we were able to come to a resolution on behalf of our members. Our new agreement with Northside continues and enhances our partnership, continuing access to quality care for Georgians, which is our focus.” Bunch thanked Northside’s leaders for “their partnership and efforts to find common ground.”
Wade and Bunch said Northside Hospital and Anthem Blue Cross and Blue Shield in Georgia have been in a contractual partnership for more than 30 years. “The successful resolution of these discussions represents a commitment to further strengthening a partnership that potentially will develop into a model for the Atlanta region and all of Georgia,” they said, adding the new agreement is effective immediately, “meaning Anthem Blue Cross and Blue Shield members will have in-network access to Northside’s hospitals, physicians, and other outpatient locations in Georgia for the foreseeable future.”
The settlement grants a wish expressed during oral arguments at the Supreme Court in May. Justice Nels Peterson noted the parties may not like the outcome of the decision and could make the entire problem go away if they could resolve their differences over reimbursement.
“It might be best for everybody for y’all to work this out and moot this case,” Peterson said. “If not, we’ll have to decide it.”
Highsmith, who made the argument for Northside, said he saw other justices nodding in agreement. “Many trial judges have looked over the bench and implored me to reach a settlement,” Highsmith said. “That was the first time I’ve heard it from a Supreme Court justice.” He added, “Message received.”
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