Northside Hospital and United Healthcare

Northside Hospital and United Healthcare

What You Need To Know

What is happening right now with Northside Hospital Gwinnett / Duluth and United Healthcare?

Northside Hospital has enjoyed a long and successful partnership with United Healthcare. However, on October 9, 2020, United notified us that it will not renew its 11-year-old agreement with the Gwinnett Health System, which now is owned and operated by Northside Hospital.

This means that the hospital agreement between United Healthcare and Northside Hospital Gwinnett and Northside Hospital Duluth will end as of March 1, 2021 if not renewed prior to that date. If this happens, United Healthcare policyholders who receive care at Northside Hospital Gwinnett and Northside Hospital Duluth could be out-of-network on March 1, 2021.

United Healthcare’s decision to not renew this agreement with Gwinnett Health System impacts only Northside Gwinnett and Northside Duluth. This decision does not impact physicians or other Northside hospitals.

It is surprising to us that United Healthcare has taken this action during the COVID-19 pandemic, but Northside Hospital is firmly committed to working with United Healthcare to find a path forward. The people of the Gwinnett area are, and will continue to be, our primary concern throughout these discussions.

Has Northside Hospital had problems with United Healthcare before?

No. For over a decade, Northside has enjoyed a strong working relationship with United Healthcare. We pride ourselves on working collaboratively with all insurance companies. That’s why this situation surprises us – particularly as we are battling a global pandemic.

My family has had serious problems during the Covid-19 pandemic. Why do we have to deal with this, too?

United Healthcare’s decision to not renew the agreements with Gwinnett Health System -- during the worst global pandemic of the last 100 years – is regrettable. It is unfortunate that you may be impacted by their decision.

Northside’s focus will remain on keeping Gwinnett residents healthy and providing them with access to the best quality health care. We are committed to working with you and your physician to ensure that your care can still be delivered at a Northside hospital.

If my family and I can’t go to our preferred in-network hospitals, what options do we have for our health care?

Northside Hospital firmly believes that an unwavering focus on patients and their families must be our goal, and that it must be shared by our insurance partners. Northside will work with you every step of the way. Fortunately, other Northside hospitals and outpatient facilities are available to you, your family, and your physician to ensure seamless access to your health care needs.

We know you will have lots of questions. Northside will help you navigate this situation to avoid health care disruptions.

We encourage you to visit Billing and Collections, where you will find guidance and many resources. You also can email customer.service@northside.com or call 404-851-6500.

Will Northside help me and my family with financial support during this situation?

If you have health insurance with United Healthcare and are forced out of the Northside Hospital Gwinnett / Duluth network, we offer financial assistance for medically necessary health care services for persons who meet Northside Hospital’s Financial Assistance Program qualification guidelines. This program could assist you if you have out-of-network benefits with your plan. To learn more about Northside Hospital’s Financial Assistance Program, you can download the Northside Hospital Financial Assistance Program Policy and Financial Assistance Application or you may contact our Financial Counseling offices to request that a copy of these documents be mailed to you. If you are an oncology patient, the Financial Assistance Application for Oncology can be found here.

If my family can’t go to Northside Gwinnett or Northside Duluth, who decides where we should go for our health care?

Even if you are out-of-network for these two hospitals, you can still be treated at these facilities – but you may have additional financial responsibility, depending on your insurance coverage. The good news is that Northside’s patient care representatives will work with you not only on the best options for your care, but also the best possible cost arrangements.

Northside has a strong and accessible health care system, which includes three other hospital campuses (Atlanta, Forsyth and Cherokee) where you would still be in-network with your United Healthcare policy. Importantly, care that you receive at your doctor’s office is not affected.

What if I have a procedure scheduled on March 2, 2021 at one of Northside’s Gwinnett hospitals – what should I do?

Please contact your referring physician’s office, so you can discuss your concerns. It’s very likely that you can have your procedure at another Northside facility – and remain in-network. You’ll also have in-network care options at our other facilities in the Gwinnett County area. Remember, your physician is not affected by United Healthcare’s terminations. Northside physicians and their staffs are among the most respected in Georgia, and they are well-equipped to help you make the best decisions on in-hospital care.

My partner is scheduled to deliver in mid-March 2021 at Northside Hospital Gwinnett. Will United Healthcare still cover our costs?

You may be eligible for “Continuity of Care.” This means that United Healthcare will consider exceptions for individuals currently undergoing active treatment for certain health conditions. You will first need to complete a form and submit it to the company. You can visit its website at https://www.uhc.com/ to get the form, or call the number on the back of your member ID card. Examples of possible Continuity of Care situations include: pregnancy (based on stage of pregnancy and risk status), current in-patient status in an acute care hospital, chemotherapy, radiation therapy, psychiatric counseling.

I’m enrolled in United Healthcare through my employer here in Gwinnett County. Will my employer be able to help?

You should be able to work with your employee benefits team to learn more about this situation and how it specifically affects you and your family.

With the confusion about United Healthcare’s coverage, how do I know if my insurance will cover the cost of my procedure?

As always, Northside Hospital billing representatives will verify your insurance coverage when you pre-register for your procedure and they will inform you if there are any problems with your coverage. To pre-register, please call 404-459-1280 or fill out our pre-registration form.

And what should I do about scheduling medical appointments after March 1, 2021?

Please contact your referring physician’s office, so you can discuss your concerns. You can also call our Concierge Line at 404-303-4291. It’s very likely that you can have your procedure at another Northside facility – and remain in-network. Remember, Northside has other hospital and outpatient locations and will make sure you have dependable options with us.

Your physician is not affected by United Healthcare’s terminations. Northside physicians and their staffs are among the most respected in Georgia, and they are well-equipped to help you make the best decisions about hospital care.

Northside’s commitment to you

The people of the Gwinnett region are, and will continue to be, our primary concern – and the reason that we will continue to work towards a solution on your behalf.

Northside Hospital firmly believes that an unwavering focus on patients and their families must be our goal, and that it must be shared by our insurance partners.

We also believe that both Northside Hospital and United Healthcare can find a solution – as long as every discussion begins, and ends, with a commitment to ensure access to quality health care for the citizens of the Gwinnett region. This is the necessary outcome.