Nearly 80,000 Georgia residents are being affected by UnitedHealthcare and Wellstar's failure to renew their in-network contract, which expired Oct. 3.
While UnitedHealthcare does have a secondary contract with Wellstar through MultiPlan, its primary commercial network contract with the provider has expired, according to Wellstar's website.
As negotiations continue, Wellstar has allowed UnitedHealthcare to offer members the provider's reimbursement rates associated with the MultiPlan agreement if it chooses to do so, a Wellstar spokesperson told Becker's. However, a UnitedHealth spokesperson denied that there is secondary contract through MultiPlan, meaning patients receiving elective, non-emergent services without prior approval will face out-of-network costs.
The parties did negotiate an extension for Medicare Advantage beneficiaries through Dec. 31, which only affects UnitedHealthcare members who have preexisting relationships with Wellstar, according to a UnitedHealthcare spokesperson.
A Wellstar spokesperson said renegotiating its primary commercial contract with UnitedHealthcare has been an ongoing effort for years.
"Unfortunately, UnitedHealthcare has allowed current contract negotiations to fail, leaving thousands of Georgia patients without access to primary in-network care and services from Wellstar hospitals and physicians," a Wellstar spokesperson told Becker's. "We are disheartened by this development. Our top priority is the health and well-being of our patients, and we are continuing to seek a fair agreement from UnitedHealthcare that will allow patients to maintain primary in-network access to the local Wellstar physicians, hospitals, and services they know and trust."
A UnitedHealthcare spokesperson said Wellstar issued a termination notice in the spring of 2021 with a first-year price hike that would make the provider 40 percent more expensive than other hospitals in the area.
"Wellstar’s hospitals are already the most expensive in Atlanta, yet Wellstar refused to move off its demands for an egregious 37 percent 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," a UnitedHealthcare spokesperson told Becker's. "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."
UnitedHealthcare and Wellstar pointed fingers in the days leading up to the deadline, with each accusing the other of demanding outrageously high rates.
Editor's Note: This story has been updated to more accurately reflect contested claims between both parties.