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UnitedHealthcare skirmish may leave Forsyth customers out of network

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Northside Forsyth

Negotiations are at a stalemate between Northside Forsyth Hospital and UnitedHealthcare for in-network coverage. With the current agreement set to expire Aug. 1, those insured by UnitedHealthcare could face out-of-network expenses for healthcare at the county’s largest medical care provider. 

FORSYTH COUNTY, Ga. — Forsyth County residents insured by UnitedHealthcare could soon find visits to Northside Hospital Forsyth classified out-of-network.

The hospital network and major insurance provider’s agreement for in-network care is set to expire Aug. 1. If the deadline passes without the two sides inking a deal, thousands across the Metro Atlanta area, including in Forsyth County, could be forced to find an alternative in-network medical provider.

If a deal is not struck by Aug. 1, Northside’s Forsyth County, Atlanta and Cherokee County hospitals will be out-of-network for employee-sponsored, individual and UnitedHealthcare’s Medicare Advantage Plan, including its National PPO plan.

UnitedHealthcare’s contracts with Northside’s ancillary locations, ambulatory surgical centers, its Northside employed physicians — including those at Gwinnett Medical Group and Northside Medical Group — will not be affected if a deal is not struck, UnitedHealthcare said.

Both sides have kept their cards close to the vest on details, but the issue stems from a cost agreement that has left talks at a stalemate.

"Northside and United Healthcare have continued regular discussions for quite some time,” Northside Hospital Vice President Lee Echols said.  “While we have not reached an agreement on what's best for Northside's patients who have lost their health care coverage, we're committed to fixing this situation. We hope that United will do the same."

The hospital system has stepped up the pressure.

Attorney Sam Olens, who is representing Northside, asked members of the Forsyth County Commission to send a letter to UnitedHealthcare urging it to facilitate an equitable agreement. Commissioners approved the letter by unanimous vote.

For its part, UnitedHealthcare says it is meeting with Northside officials to renew its contract for Northside’s Atlanta, Cherokee County and Forsyth County hospitals. The firm says it desires to keep these facilities in-network, but at a lower cost to customers.

“Throughout several months of negotiations with Northside, we’ve been focused on our goal of making health care affordable for the residents and employers we serve in Atlanta,” UnitedHealthcare said in a statement to the Herald. “We have made significant compromises in an effort to renew our relationship and ensure our members have continued access to affordable care at Northside’s hospitals.”

The local fight between the companies comes after United and Northside failed to reach an agreement for in-network coverage in Gwinnett County. On March 1, Northside Hospital Gwinnett and Northside Hospital Duluth went out of network for employee-sponsored and individual plans for UnitedHealthcare customers.

United says it is still looking to reach an agreement with Northside to resume in-network coverage at the Gwinnett hospitals in addition to its Forsyth County, Cherokee County and Atlanta hospitals.

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