Born with half a heart; Georgia health care for children in limbo as hospitals, insurance companies negotiate | Investigate

CUMMING, Ga. (CBS46) – The deadline for Northside Hospital System and Anthem Blue Cross Blue Shield to come to an agreement on health care and insurance is approaching.

Otherwise, hundreds of thousands of Georgians will be forced to seek new health care starting January 1 or be forced to pay large out-of-pocket bills.

While contract disputes are not new, as CBS46 investigative reporter Rachel Polansky discovered, they have become much more common and are affecting people’s ability to access health care. friend.

Mason Lang

Mason Lang

Mason’s story:

Behind the mask and shield is a kid named Mason, with a really big heart. Beside him is his supportive and caring mother, Tonya.

“I’m so proud of him. He’s come a long way,” said Tonya Lang.

Mason was born with a congenital heart defect known as ‘Hyperplastic Left Heart Syndrome’ or HLHS. Basically, he has half a heart.

Mason Lang

Mason Lang

“I don’t really see it as a big deal,” Mason said.

The 10-year-old boy relies on doctors in Northside Forsyth.

“Mason had a severely small left ventricle that would not have been able to sustain him, so he had to undergo a series of heart surgeries,” Lang said.

Mason with Tonya

Mason and Tonya Lang

That’s why Lang was so outraged when she found out her insurance company and her hospital system couldn’t directly see him caring for him.

“Northside told me as of December 31, they will cease operations and will no longer take insurance,” Lang said.

Lang is part of 400,000 Georgians who will have to find a new provider if Northside Hospital System and Anthem Blue Cross Blue Shield fail to reach an agreement by the end of the month.

Northside, Anthem BCBS respond:

Now, there’s a lot of palmistry going on. These are the statements CBS46 received from both parties regarding the dispute.

“Northside Hospital has successfully partnered with Anthem Blue Cross Blue Shield for over 30 years. Despite this long-standing relationship, Anthem has notified us of its intention to terminate its agreements with the entire Northside Hospital System, effective December 31, 2021. surprise for Northside – our agreements with Anthem are non-renewable and have not expired. Nearly 400,000 Northside patients may be affected by this unplanned termination. Anthem’s threat is also disrupting the open enrollment period, as patients are deciding to choose healthcare coverage for their families in the coming year. Northside has called tens of thousands of patients, keeping them informed of Anthem’s intentions and providing guidance in their decision-making.” -Lee Echols, vice president, Northside Hospital

“In the metro-Atlanta area, healthcare costs are escalating rapidly. Northside is one of the most expensive systems in Georgia, and the current contract does not match incentives to improve the quality and affordability of our members. That is why we have informed officials at Northside that we plan to reach a new agreement by the end of the year so that we can keep its facilities and doctors in our network. we. We know that by working together we can ensure higher quality and better health outcomes for our members. “-Anthem Blue Cross Blue Shield

Anthem Blue Cross Blue Shield also noted that it has renegotiated several new provider agreements over the past year without interruption, with HCA Healthcare, Piedmont, Cancer Centers of America, Optim Health System, Grady, Trinity Health and Emory.

Next trend:

“We still don’t see the cost to consumers going down as hospitals consolidate. What happens when there is less competition always happens: prices go up,” said Liz Coyle, head of consumer advocacy, Georgia Watch.

“We are seeing contract disagreements like this across the country,” Coyle said. And she blames it on two things:

1) Market consolidation. That’s when we see mergers involving two large companies that offer similar services like anthem and blue cross blue Shield.

2) The network standard does not match. That’s when your insurance plan doesn’t give you enough access to reliable providers in your area.

Coyle goes as far as to say that like surprise payments, this is the next big issue in the healthcare debate and the only way to fix it the same way we fixed it: through law.

“Something like that needs to happen in this case,” Coyle said. “That disagreement shouldn’t leave 400,000 people without access to a trusted provider or taking long distances to get care in the network.”

For people like Mason Lang, caring can mean life or death.

“It’s a shame for them to put everyone in this situation,” Lang said. “To think they’re throwing people’s lives up in the air for dollars, it makes me so angry.”

The deadline for the Northside Hospital System and Anthem Blue Cross Blue Shield to come to an agreement is December 31. A recent contract dispute between Blue Cross Blue Shield and the Oklahoma hospital system down the line and they reached an agreement in the 11th hour. So there is hope that could happen here. Meanwhile, hundreds of thousands of Georgians are in limbo.


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