Wellstar now out of network for employer-sponsored, individual and Medicare Advantage plans

Although we negotiated in good faith for several months, we were not able to reach an agreement with Wellstar Health System following its decision to terminate the contract we just renewed in the summer of 2020. As a result, Wellstar’s hospitals and employed physicians are now out of network for our employer-sponsored, individual and Medicare Advantage plans as of Oct. 3, 2021.

Wellstar accepted our proposal to allow our Medicare Advantage members who are active patients at Wellstar to continue to have network access to Wellstar’s hospitals and physicians through Dec. 31, 2021. Medicare Advantage members who are not active patients at Wellstar no longer have network access to the health system’s hospitals and physicians, as of Oct. 3, 2021.

We issued the following statement regarding Wellstar’s decision to leave our network.

“Wellstar’s hospitals are already the most expensive in Atlanta, yet Wellstar refused to move off its demands for an egregious 37% price hike over three years that would have increased health care costs by more than $109 million. This is not sustainable or affordable for the people and employers we serve. While it’s unfortunate Wellstar terminated the contract we just renewed in the summer of 2020, our top priority at this time is ensuring our members have access to the care they need and supporting them as they transition to one of the more than 30 hospitals and approximately 12,000 physicians that participate in our network in Atlanta and the surrounding communities.”

Important update

Wellstar has communicated inaccurate and misleading information to our members by stating they’ll still have in-network access to Wellstar’s hospitals and physicians through a secondary agreement with MultiPlan. This is not true. There is no ‘secondary contract’ with Multiplan that provides in-network access to Wellstar.

Members who receive elective, non-emergent services at any Wellstar facility or with any Wellstar physician that have not been previously approved for continuity of care will be subject to higher out-of-pocket costs. These services will be considered out of network.

It’s unfortunate that Wellstar terminated its contract with UnitedHealthcare and is now willfully spreading misinformation in the community that will mislead its patients into thinking they can continue to receive in-network care at its hospitals and with its physicians when instead they would be subjecting them to out-of-network charges.

If Wellstar wants its claims to process in-network, it can do so by engaging in productive negotiations and rejoining our network at rates that are affordable for the people and employers we serve throughout Georgia.

Key information for our members

  • Wellstar has also confirmed it will continue to provide care to members enrolled in the UnitedHealthcare Group Medicare Advantage National PPO plan, including the Medicare Advantage State Health Benefit Plan for retirees. As a result, all members enrolled in this plan will continue to have access to Wellstar’s hospitals and physicians. Our Group Medicare Advantage National PPO plan gives our members the flexibility to see care providers that don’t participate in our network for no additional out-of-pocket cost beyond what they would pay to see a network provider.
  • Please note that we have direct contracts with the majority of the physicians affiliated with Wellstar Clinical Partners (WCP), the system’s clinically integrated network. Our members will continue to have network access to these physicians despite Wellstar leaving our network.
  • Visit information our members should know about alternate hospitals and physicians, as well as continuity of care. 

Wellstar’s continued demand for egregious price hikes

Wellstar’s hospitals are already significantly more expensive than all other Atlanta hospitals, which is why we were disappointed to see that the system was seeking a one-year, 22% price hike in its first proposal. We have reiterated to Wellstar on many occasions that our focus is making health care more affordable for the people of Atlanta and companies doing business here. Unfortunately, there are no indications, based on all of Wellstar’s proposals, that our message is getting through.

The health system’s latest proposal includes demands for a price hike of 37% over the next three years, which would increase health care costs by more than $109 million. Wellstar’s proposal also includes a more than 15% price hike for its hospitals and physicians in the first year of the contract. Agreeing to this would increase health care costs by $51 million in just one year and would make the rates at Wellstar’s hospitals more than 40% higher than the average cost of all other hospitals in Atlanta.

As part of our efforts to get a deal done, we made significant compromises to accommodate Wellstar’s request to more fully recognize Wellstar Clinical Partners (WCP) under a new contractual arrangement. While 98% of the WCP physicians participate in our commercial network through direct contracts that allow our members to take advantage of Wellstar’s clinically integrated network as of today, we made this movement as part of our good-faith efforts to reach an agreement. Unfortunately, Wellstar continues to spread misinformation regarding the progress we’ve made on the WCP agreement. Wellstar is well aware the core issue that remains in our negotiation is the egregious increase it’s seeking for its hospitals over the next three years, which are already the highest cost in Atlanta.

We recognize that this has been a challenging process for our members and the employer group customers we’re honored to serve, and we do not take this type of potential disruption in the market lightly. We continue to ask that Wellstar come to the negotiating table with a realistic proposal that’s affordable and sustainable for the people and employer group customers we serve. We will remain at the negotiating table as long as it takes to try to reach an agreement.