Updated June 30, 2023
Northeast Georgia Health System now out of network for employer-sponsored and individual plans
Despite repeated efforts to reach a compromise, we were unable to renew our contract with Northeast Georgia Health System (NGHS). As a result, NGHS’ hospitals, facilities and its physicians are now out of network for our employer-sponsored and individual plans, as of May 1, 2023.
Our goal has always been to reach an agreement that is affordable for Georgians and employers while avoiding any disruption to care for the people we serve. Unfortunately, NGHS refused to move off its continued demands for a more than 20% price hike over the next three years, including a double-digit rate increase in the first year that would make its hospitals the most expensive in Georgia.
We provided a fair and reasonable proposal on March 31 that included meaningful rate increases. NGHS refused to respond to our proposal and cancelled all of our meetings over the past few weeks, choosing to allow our contract to expire and unnecessarily disrupting Georgians’ access to its hospitals and physicians.
While we remain committed to continued discussions with NGHS, our focus now is ensuring the people we serve have access to the care they need through either continuity of care or a seamless transition to a new provider. We have created the following page dedicated to information about continuity of care as well as alternative hospitals and physicians remaining in our network.
Please note: NGHS has stated on its website that people enrolled in the UnitedHealthcare Group Medicare Advantage National PPO plan, including the Medicare Advantage State Health Benefit Plan for retirees, are not impacted by this negotiation. People enrolled in this plan will continue to have access to NGHS’ hospitals and physicians.
NGHS is demanding a more than 25% price hike over the next three years, including a double-digit rate increase in the first year that would make its hospitals the most expensive in Georgia.
NGHS’ demands are not affordable or sustainable and would drive up premiums and out-of-pocket costs for Georgians as well as the cost of doing business for both self-insured and fully insured companies, impacting their ability to offer health care coverage for their employees.
Third-party data indicates NGHS is one of the most expensive health systems in the United States, including higher than some of the country’s most prestigious hospitals.
Northeast Georgia Medical Center is reimbursed 429% of CMS on average, higher than each of the top 10 hospitals in U.S. News and World Report’s rankings for best hospitals in the United States, according to the Sage Transparency Tool*. These hospitals are nationally known as some of the best in the country for providing high-quality health care.
*The Sage Transparency Tool compares hospital prices across 4,000 health systems and facilities in the United States. The tool contains standardized hospital price data from RAND 4.0 Hospital Price Transparency Study and standardized and relative price data of more than 2,000 ambulatory surgery centers (ASCs), facilities that perform outpatient surgeries, from across the country. There are also updated price and quality metrics from the Centers for Medicare & Medicaid Services (CMS), National Academy for State Health Policy (NASHP), Turquoise Health, and Healthcare Bluebook included.
Agreeing to NGHS’ demands would mean one of our self-funded customers would see their health care costs increase by more than $3.5 million, while several others would see increases of more than $380,000 to nearly $540,000 over the next three years.
NGHS’ rate demands would directly drive up health care costs for our self-insured customers given that these employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims. In Georgia, more than 70% of our commercial members are enrolled in self-insured plans.
NGHS’ proposal for egregious price hikes when its hospitals are already charging exorbitantly high rates would impact many businesses’ ability to continue offering affordable health care coverage for their employees. It would also mean they have less money available to pay competitive wages and to help grow the business through things like investments in new technologies.
The cost of care at NGHS’ hospitals is 47% higher than the average cost of hospitals in our network throughout northern Georgia. NGHS is also an outlier when compared to hospitals throughout the state.
The cost of a surgery at NGHS is 29% higher than the state average, while radiology services are 35% more expensive at NGHS compared to the state average of hospitals participating in our network.
NGHS charges egregiously high rates even for common services, tests and surgeries when compared to its peers. Consider the following examples:
- The cost of an MRI at an NGHS hospital is 2 ½ times higher – or approximately $1,600 more – than it would cost on average to receive the same test at another hospital participating in our network in north Georgia.
- The cost to receive a CT scan at NGHS is nearly $1,400 more than the average cost at other hospitals throughout north Georgia.
- The average cost of an outpatient surgery at an NGHS hospital is nearly $11,000 more than the average cost at peer hospitals throughout north Georgia.
- The cost of an emergency room visit at NGHS is approximately $1,500 more – or 65% higher – when compared to the cost at hospitals in north Georgia, and 42% higher when compared to the state average.
We remain committed to good-faith negotiation with the goal of reaching an agreement that is affordable for the Georgians and employers we serve
We know many people have developed personal relationships with their NGHS physician, value having access to the health system and are rightfully concerned by this news. Please know we remain committed to continued discussions with NGHS. However, we need the health system to join us at the negotiating table and work with us to find a solution that is affordable for the businesses and people we serve.