While contract negotiations between The Medical Center of Central Georgia and United Healthcare are apparently not over, a memo was sent out to Macon area doctors this week saying an agreement had been reached.
A contract dispute between the hospital and the insurance provider developed earlier this year over reimbursement payments. The end result is that the Medical Center became an out-of-network provider for United Healthcare insurance, which would cost members more for treatment. United Healthcare is one of two providers offered to state employees.
Hospital officials say United Healthcare did not honor its contract, but the insurance company ran an ad in The Telegraph saying it is in compliance with the contract.
The two sides have been in negotiations recently to try to settle the matter.
After a negotiation meeting Wednesday, a memo was sent to area doctors by the Central Georgia Health Network — the contract negotiating arm for the hospital — which said an agreement would go into effect Aug. 9, even though a contract wouldn’t be signed until October.
But that’s not the case, say officials from the Medical Center and the insurance company.
“An agreement has not been reached,” hospital CEO Don Faulk said Friday.
“That was a target date mentioned in an internal correspondence to the physician community from the negotiating arm. But I think it’s premature to set dates given the uncertain direction of the way negotiations unfold.”
United Healthcare took a similar position.
“We are continuing to negotiate with the Medical Center and we are hopeful we will come to a resolution,” United Healthcare spokeswoman Tracey Lempner said Friday. “We have agreed mutually to focus on negotiations. ... No agreement has been reached.”
Road to the dispute
The insurance company offered members a PPO plan and an HMO plan, and Faulk said the hospital’s insurance office began noticing in January that all payments were coming in at the HMO rate, which was lower than the PPO rate.
“Apparently what happened is United Healthcare moved the state merit members (into the HMO plan),” without notifying the Medical Center. At that point, members were not affected, only what the hospital got paid, he said.
“The lower rates were costing us about $500,000 a month,” Faulk said. “We began a dialogue, and a dispute obviously arose over the contract.”
About 125 patients a month at the Medical Center are covered by United Healthcare insurance, he said.
Then in May, the hospital became aware United Healthcare was sending letters to doctors that they would be out of network if they used the Medical Center, Faulk said.
“United Healthcare wanted to wait until the end of the (calendar) year to fix it,” he said. “They said that their client is the state and they have budget issues.”
Faulk said he tried to work directly with the state at the end of June.
“They have said to us: ‘Work with United,’ ” he said.
The hospital didn’t want to wait until the end of the year and began the legal process of settling the dispute.
“It will be settled one way or another,” Faulk said. “They say they haven’t broken the contract and we think they have.”
United Healthcare of Georgia CEO Rick Elliott said in The Telegraph advertisement that members could still receive in-network care at other participating hospitals including the Coliseum Medical Center, Coliseum Northside Hospital and Houston Healthcare.
United Healthcare members who need trauma care would still be covered at the in-network benefit level at the Medical Center, the ad states.
Faulk said he couldn’t put a deadline on when the dispute may be resolved.
“I am committed to getting it done just as soon as we can reach an equitable contract,” he said. “That’s absolutely my target. But I don’t want to sacrifice quality for speed.”
To contact writer Linda S. Morris, call 744-4223.
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