Thousands Left With Questions As Wellstar, United Contract Lapses

GEORGIA — After months of negotiations, Wellstar Health System and UnitedHealthcare did not reach an agreement before their primary commercial contract expired Sunday — leaving thousands of people without insurance options and with tons of questions.

As of Oct. 3, Wellstar's hospitals and employed physicians are no longer considered in-network providers for those insured under United's employer-sponsored, individual or Veteran Affairs Community Care Network plans. The contract lapse does not affect patients with the AARP Medicare Supplement from United.

"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," United said in a statement Monday. "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."

United's Medicare Advantage members will still have coverage through the end of the year, but Wellstar is encouraging these members to pick a new Medicare Advantage plan that includes in-network access to Wellstar providers during the open enrollment period, which runs from Oct. 15-Dec. 7.

Those with the State Health Benefit Plan UnitedHealthcare Medicare Advantage (for Retirees) will remain in-network through the end of the year. Even if a further contract extension does not happen for 2022, these patients will still be able to to use Wellstar physicians and hospitals under the out-of-network benefit at no additional cost, Wellstar officials said.

For emergency room visits, United said its members will be covered as in-network, regardless of the hospital's network status. Patients in the middle of treatment for "serious conditions" — such as women in late stages of pregnancy and patients needing cancer treatments — would also still be covered if they're already being treated by Wellstar doctors or at Wellstar hospitals.

Despite the contract lapse, Wellstar said United members still have a form of in-network access to Wellstar through a secondary commercial contract between United and the company MultiPlan. United members can access Wellstar doctors and hospitals through the MultiPlan agreement, which offers "a substantial discount from Wellstar's normal out-of-network charges" until a new contract is negotiated.

"In other words, UnitedHealthcare can access contracted rates for Wellstar physicians and hospitals on behalf of you and your family — if it chooses to do so," Wellstar officials said in a statement Monday. United did not clarify if it would choose to pay the MultiPlan rates.

United and Wellstar agreed on a primary commercial contract last summer, but United claims Wellstar demanded a 22 percent price hike in order to approve a contract again this year. This was the main reason the two companies could not reach an agreement before Sunday.

"Agreeing to this would drive up health care costs by more than $75 million in the first year alone, which is not sustainable or affordable for the community, our members and the employer group customers we serve," United said in a statement. "It’s unrealistic for Wellstar to demand such an egregiously high rate increase when its hospitals are already significantly more expensive than all other Atlanta hospitals that provide similar services."

Meanwhile, Wellstar pointed out its not-for-profit status and accused United and its parent company of choosing "profit over patients," as it reported a $22 billion profit last year amid the COVID-19 pandemic.

Wellstar also said United has "recycled the same argument with health systems and hospitals across the country over the last year," citing multiple examples including the contract rift in March between United and Northside Hospital, which was renewed in August.

"For far too long, UnitedHealthcare has been interfering in the patient/doctor relationship, increasing denials for needed services and failing to reimburse health systems like Wellstar at fair rate," Wellstar officials said in a statement. "Because of the current outdated agreement, UnitedHealthcare members are unable to take full advantage of the whole Wellstar integrated network of care."

Both UnitedHealthcare and Wellstar said they are still continuing negotiations and hope an agreement can be met in the near future.

To contact Wellstar with questions, visit online. To contact UnitedHealthcare, visit online or call the number on the back of your health plan ID card.