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Hamilton Plans Contract Discussions Next Month With Four Large Insurance Companies

Hamilton Health Care System and Blue Cross Blue Shield of Georgia have reached an agreement to provide health care services for the University System of Georgia.

The agreement will allow any of the 50,000 employees and retirees of the university system, including those at Dalton State College, to receive care at either Hamilton Medical Center or Murray Medical Center as part of Blue Cross’ preferred provider organization (PPO) network. The agreement will also mean university employees and retirees will have access to more than 200 physicians in the area, according to Blue Cross.

In a statement, Blue Cross said Hamilton placed talks to cover all of Blue Cross’ PPO customers on hold on July 14. But Hamilton and Physicians Health Services, which represents almost all of the area’s doctors, say they will begin negotiations next month with Blue Cross and other major health insurance companies that may bring the hospitals and local doctors into those companies’ PPO networks.

“We are planning to start having language discussions, contract language discussions next month,” said David McCreery, president of Physicians Health Services. “That is the first step. Depending on how quickly they are willing to move on that, we are ready to proceed with at least the four major players in the marketplace.”

McCreery says those companies are Blue Cross Blue Shield, United Healthcare, Aetna and Cigna, the four largest health insurance companies nationwide.

“We plan to actively contact them, not just sit back and wait on them to call us,” he said.
Hamilton, and many local doctors, do not currently accept those major plans.

“We want the community to know we have heard the community’s request to access our services through a wider variety of insurance plans, and we are working hard to extend our relationship with Blue Cross and other national insurers,” said Hamilton CEO John Bowling.

Will having reached an agreement on university employees make it easier for Hamilton and Blue Cross to reach an overall agreement?

“Blue Cross and Blue Shield of Georgia has approached the two discussions independently of one another and does not feel that one discussion will impact the other,” Blue Cross said in the statement.

Bowling says that the university agreement might make it a bit easier since each side is now more familiar with each other’s concerns.

“The caveat would be that this is a Board of Regents matter. Therefore, they control it, not Blue Cross. Blue Cross just serves as a third party administrator. Blue Cross is not the payer there, and where Blue Cross is the payer, there’s likely to be some different contractual language,” he said.

Hamilton and Physicians Health Services say clinical integration — developing a common set of clinical protocols for all physicians — will be key to contract negotiations. They had set a deadline of July 31 to complete that process.

“The plan was to try to do that. It was really a deadline requested by the Chamber of Commerce. We are running a little behind that schedule. There have been some unanticipated difficulties with the information systems of the physicians,” said McCreery. “But we have made a lot of progress. We are getting real close to saying that we are clinically integrated. We’re trying to make sure the difficulties we have encountered don’t slow down our ability to engage in the contracting process.”
In April, several local business leaders sent a letter to Bowling asking for local health care providers to take part in a larger number of health insurance networks.

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