Atlanta - Contract disputes between insurance providers and hospitals are not new, and they can go down to the wire.
But, Tonya Lang of Cumming, Georgia, says the stalemate between Northside Hospital in Atlanta and Anthem Blue Cross Blue Shield has left her family and many others stuck in limbo
Lang's nine-year-old son Mason was born with a severe heart defect that has required a lot of surgery and specialized care over the years.
So, Lang was frustrated to learn Mason's visits to nearby Northside Hospital facilities and doctors may no longer be covered by their Anthem/Blue Cross Blue Shield insurance plan, as of December 31, 2021.
"I was pretty upset because Northside, in the event of an emergency, is the closest hospital to us," Lang says. "Right now, while he's a child, luckily, Children's Healthcare of Atlanta takes care of most of his needs. But, every now and then we do have to use Northside doctors, and we're still trying to sort out for him which of those doctors are Northside-affiliated and can we move on from them."
In a statement to FOX 5 Atlanta, Lee Echols, vice president of Northside Hospital wrote the hospital system was caught off guard by Anthem's move to renegotiate their contract.
"This decision surprised Northside – our agreements with Anthem were not up for renewal and were not set to expire," Echols writes. "Nearly 400,000 Northside patients could be affected by this unplanned termination."
Anthem says it has reached similar agreements this year with other Georgia hospital systems, including Grady Health System, Piedmont Healthcare and Cancer Treatment Centers of America without any disruptions for its members.
In a statement to FOX 5, the company writes, "In the metro-Atlanta area, healthcare costs are escalating rapidly. Northside is one of the most expensive systems in Georgia, and the current contract doesn’t adequately align incentives to improve quality and affordability for our members."
Lang says she understands this is a business deal.
But Lang says Mason and 400,000 other patients are caught in the middle of this and need some answers soon.
"You have people out there who are getting dialysis treatment, cancer treatment, that are kind of left hanging," Lang says. "And, it's just devastating for those people and frustrating that we have to go through this."
Anthem says it has notified some members, who are currently in treatment for pregnancy, cancer and kidney care that they may be eligible to continue with their care at Northside facilities or through its providers for the short-term, as the two sides try to work this out.