Clock ticks on state health insurance plan - WALB.com, Albany News, Weather, Sports

Clock ticks on state health insurance plan

November 17, 2005

Albany -- Tomorrow's the deadline for school teachers and other state employees to make health coverage decisions under the state's new contract with United Healthcare.

And as late as today, Phoebe Putney Hospital and United Healthcare are still negotiating over health care providers for South Georgia state employees.

But the hospital says even if it becomes a preferred provider, a lot of doctors in the area aren't.

Georgia signed United Healthcare to provide health coverage for the state's 610,000 employees. But in South Georgia, the insurance company has few doctors or hospitals under contract. Phoebe says its close to working out a contract with United.

But even then, most Doctors would not be preferred providers, which could cost the patient more to use. "But there are a lot of bases that still have to be touched, especially in the physician community. And our worry is that is the piece that is still unresolved." said Phoebe C.E.O. Joel Wernick.

Many Southwest Georgia Doctors have refused to sign with United Healthcare, saying the contract is not good for their business.

United Healthcare's problems continue in Georgia. The Medical Centre of Central Georgia in Macon announced it plans to terminate it's contract with United because of "Substantial breach of contract."

United Healthcare is also facing a possible $2.4 million fine by the state Insurance Commissioner for failing to pay thousands of health claims in a timely manner.

Meanwhile, late Thursday afternoon, WALB received this press release from the Governor's office:

State of Georgia and United Health Care Systems Reach Agreement on the State Health Benefit Plan

 

ATLANTA – Governor Sonny Perdue announced today that United Health Care Systems has agreed to include three provisions in its contract that were the primary sticking points between United and doctors and hospitals.

 

“We’ve been closely observing negotiations between United and healthcare providers and it became clear that hospitals and physicians were not being heard,” said Governor Sonny Perdue.  “Today we made it clear the state was willing to move in another direction if the company could not address the needs of the marketplace immediately.  Our primary interest has always been providing quality healthcare and a comprehensive, adequate network for our teachers, state employees and retirees.”

 

United agreed to the following three provisions that will provide a comprehensive provider network for teachers and state employees:

  • Participating physicians must be given the opportunity to opt-out of any other United products, provided however, that they agree to participate in all SHBP options.

  • United must ensure that participating physicians are given the opportunity to opt-out of any additional United network.

  • Participating physicians must be given notice and the clear methodology regarding the calculation of the applicable fee reimbursement schedule at the time they enter into any agreement with United or agree to participate in any additional United product or network.
     


 

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