Jan 4, 2022

Fulton County Superior Court Enjoins Anthem Blue Cross from Terminating Participating Providers During Public Health Emergency

In 2021, House Bill 454 was approved by both houses of the Georgia General Assembly and signed by Gov. Brian Kemp. Most commentators have focused on the section of the legislation requiring insurers to reimburse providers at in-network rates for 180 days if that provider became out of network for a covered person during the following plan year, after open enrollment. That provision went into effect on January 1, 2022.

However, two companion cases seeking declaratory judgment and injunctive relief brought in Fulton County Superior Court by Northside Hospital and several affiliates (collectively, “Northside”) against Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (d/b/a Anthem Blue Cross) (“Anthem”) have focused attention on another section of the law which became effective on July 1, 2021, which provides:

In the event of a public health emergency . . . an insurer shall, for a period commencing on the effective date of the public health emergency and ending 150 days after the expiration of such public health emergency . . . be prohibited from terminating a provider from the insurer’s network . . ..”

Although the agreements between Northside and Anthem were not up for renewal or set to expire, Anthem notified Northside that all of its agreements with Northside would terminate as of January 1, 2022. As stated in the Complaint,

This purported termination was not borne out of underperformance by Plaintiffs. Rather, it was a play for leverage in negotiations over new contracts. This gamesmanship comes in the midst of a global pandemic that has killed at least 31,000 Georgians and currently leaves over 1,000 hospitalized. Plaintiffs are entitled to a declaration by this Court that defendants did not– and cannot — legally terminate them as health care providers from Anthem’s insurance network because said termination would violate Georgia law, which prohibits insurers from terminating providers from insurance networks until 150 days after the cessation of a public health emergency, such as COVID-19, which is still ongoing.

On December 30, 2021, the Court granted Northside’s motions for temporary injunctive relief, effectively barring Anthem’s termination notices from going into effect. Northside’s request for declaratory judgment has not yet been decided by the Court, but the injunction provides a more level playing field on which the parties can work toward a long-term agreement. Of course, the effect of HB 454 is not limited to these cases. Any provider receiving a notice of contract termination from a payor during a public health emergency (including COVID-19) should consider conferring with counsel to develop an appropriate response.

Northside Hospital, Inc.; MRI & Imaging of Georgia, LLC v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. d/b/a Anthem Blue Cross, et al., Fulton Superior Court, case number 2021cv358403, and

Northside Hospital, Inc.; Laureate Medical Group, P.C. v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. d/b/a Anthem Blue Cross and Blue Shield, et al., Fulton County Superior Court, case number 2021cv358406.

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