City DopeNews

Will UnitedHealthCare Patients Pay More or Be Forced to St. Mary’s After ARMC Merger?

For now, a commonly used health insurance plan in Athens is still in network at Athens Regional Medical Center, but that could change once the hospital is taken over by Atlanta-based Piedmont Healthcare.

A contract dispute over reimbursement rates means that, as of July 1, UnitedHealthCare plans are out of network at five of the six metro Atlanta hospitals Piedmont owns, so about 150,000 Piedmont patients with UHC plans must pay higher prices or find another hospital where their plan is still in-network. The exception is a hospital in Covington that Piedmont recently acquired and is not part of the contract.

ARMC spokeswoman Elaine Cook confirmed that UHC is still in network at ARMC, but it’s unclear whether it will stay that way. Cook told Flagpole that she can’t discuss the issue further until Piedmont’s merger with ARMC’s parent company, Athens Regional Health System, is finalized Oct. 1, because talks are still ongoing.

The basic framework for the merger was approved by the Athens-Clarke County Commission in May and the state attorney general’s office in June. ARMC will maintain some local control through its local boards, and local hospital staff will continue to run its day-to-day operations, although budgets will be set and major strategic decisions made by Piedmont. The deal will bring $195 million in debt relief and $375 million in capital investment to the local hospital.

Part of the rationale for combining forces was to gain additional leverage in negotiations with insurance companies. “It boils down to, if you don’t have scale, it really is hard to compete,” Jim Hopkins, chairman of the ARHS board of trustees, told commissioners in April.

UHC plans are also in network at St. Mary’s Hospital.