Hospitals, insurers at odds over cost; Ga. senator responds to CBS46 investigation

Senator Hufstetler pointed to a 2015 bill that sought to resolve disputes between insurance providers and hospital systems by sending them to arbitration.
Updated: Jan. 31, 2022 at 5:39 PM EST
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KENNESAW, Ga. (CBS46) — A CBS46 investigation finds contract disputes are putting healthcare for hundreds of thousands of Georgians at risk. Several local hospital systems and insurance providers are at odds over cost.

It’s an ongoing problem that experts say is only getting worse. That’s why CBS46 investigative reporter Rachel Polansky took her findings to lawmakers -- who say it’s a problem that they plan to address.

A Common Problem

“You’ve got these powerful interests on the healthcare side and insurance side with enormous amounts of leverage,” said Liz Coyle, Exec. Director, Georgia Watch.

Liz Coyle, who heads consumer advocacy agency, Georgia Watch, says we’re seeing contract disputes between hospital systems and healthcare companies nationwide. And she blames it on two things.

  • Consolidation of the marketplace. That’s when we see mergers involving two major companies that provide similar services like anthem and blue cross blue shield.
  • Inadequate network standards. That’s when your insurance plan doesn’t give you enough access to trusted providers in your area.

“We’ve yet to see costs go down for consumers when hospitals merge. What happens when there’s less competitions always happens: prices go up,” Coyle said.

Coyle goes as far as saying that just like surprise billing, this is the next big issue in the healthcare debate and the only way to fix it is the same way we fixed that is through legislation.

Ga. Lawmakers Respond

CBS46 Investigates went to the capitol. We brought findings from this ongoing investigation to State Senator Chuck Hufstetler – who co-sponsored surprise medical billing legislation in 2020 – and is passionate about healthcare issues.

“The patient is being used as a pawn in the middle of these negotiations. We’ve got to fix this. We fixed this with surprise billing for emergency situations. Now, we’ve got to fix it for non-emergency situations as well,” said Senator Chuck Hufstetler, (R) Rome.

Not only was he aware of contract disputes but he also offered a possible solution, pointing to a 2015 bill that sought to resolve disputes between insurance providers and hospital systems by sending them to arbitration.

“We need to require these people to follow some ground rules that don’t let the patients be used as pawns,” Senator Hufstetler added.

So, how soon might we see legislation? CBS46 investigative reporter Rachel Polansky asked Senator Hufstetler that question directly. Senator Hufstetler smiled and said “I think you will see something this session.”

It’s something hundreds of thousands of Georgian’s will be watching closely, as legislative session ends March 31.

Sandy’s Story

He became a teacher to make a difference.

“If I can do something for a kid, teach them even one thing, it’s a blessing,” said retired Cobb County teacher, Sandy Arroyo.

But now, the 75-year-old is trying to teach himself the intricacies of healthcare after his insurance company, UnitedHealthcare and his hospital system, Wellstar, cut ties.

“What do I do? Where do I go from here? How do I get my bills paid? And still get the healthcare I need?” Arroyo asked.

75-year-old Sandy Arroyo is trying to teach himself the intricacies of healthcare after his...
75-year-old Sandy Arroyo is trying to teach himself the intricacies of healthcare after his insurance company, UnitedHealthcare and his hospital system, Wellstar, cut ties.(CBS46)

Sandy and his wife live in Kennesaw, roughly 15 minutes from Wellstar Kennestone, where they go fairly regularly because of pre-existing conditions.

Now, they have two options, either drive further for in-network care, or keep the same doctors, but pay more out-of-pocket.

Arroyo says it’s a large burden for a retired teacher on a budget.

“And I don’t think we should have to rely on that because we have insurance. That’s why we have insurance,” he added.

Sandy is one of 80,000 Georgians impacted by the Wellstar and UnitedHealthcare dispute – which officially expired in October.

Reps for both companies tells CBS46 Investigates that negotiations continue. Still - each places blame on the other.

Mason’s Story

If this story sounds familiar, it’s because we introduced you to Tonya Lang and her son Mason, last month.

“I’m so proud of him. He’s come so far,” said Tonya Lang, of Cumming.

Her son Mason was born with a congenital heart defect called ‘Hyperplastic Left Heart Syndrome’ or HLHS. The 10-year-old relies on the doctors at Northside Forsyth.

“Mason has a severely small left ventricle that would not sustain life for him, so he’s had to have a series of heart surgeries,” Lang explained.

The Lang’s are part of 400,000 Georgians who will have to find new providers if Northside Hospital Systems and Anthem Blue Cross Blue Shield do not come to an agreement.

While those negotiations continue, a judge extended an injunction that enables Anthem members who seek care at Northside’s hospitals, clinics, and physician practices to remain fully covered and in-network through April 15, 2022.

February 16, 2022 Update

80,000 Georgians were impacted by the Wellstar and UnitedHealthcare dispute – which officially expired in October. Reps for both companies tells CBS46 Investigates that negotiations continue. Still - each places blame on the other.

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