Judge extends order, keeping Northside patients in Anthem network until spring

Last spring she was diagnosed with a highly aggressive stage 4 breast cancer that had metastasized into her bones. She’s been receiving nonstop care ever since — surgeries, diagnoses, chemotherapy, treatments for ripple effect conditions —from Northside and doctors in its system.

Caption

Arlene Sinanian has spent 2021 and 2022 dealing with a stage four cancer diagnosis and simultaneously, the bureaucratic nightmare of a contract dispute between her insurance company, Anthem Blue Cross Blue Shield, and Northside Hospital, whose doctors and facilities are providing her cancer care. Sinanian, of Atlanta, is shown here in a photo for her pet business, Pupcakes Playcare.

Credit: Handout

Credit: Handout

Caption

Arlene Sinanian has spent 2021 and 2022 dealing with a stage four cancer diagnosis and simultaneously, the bureaucratic nightmare of a contract dispute between her insurance company, Anthem Blue Cross Blue Shield, and Northside Hospital, whose doctors and facilities are providing her cancer care. Sinanian, of Atlanta, is shown here in a photo for her pet business, Pupcakes Playcare.

Credit: Handout

Credit: Handout

Shortly after she renewed her Anthem policy last fall, she learned of the looming contract dispute. At that time the deadline for the contract termination was Dec. 31. She was told Anthem would give her a “continuity of care” exemption allowing her to stay with her caregivers at Northside if the contract lapsed.She filled out the form.

But approval didn’t happen right away, and her doctors started telling her they couldn’t schedule her.Sinanian began regular phone calls to Anthem representatives. She reports being transferred, disconnected, given incorrect information, finally told she’d be helped, then told that wasn’t true.

As the contract termination deadline approached, she was at wits’ end. “Here it’s Friday, I’m supposed to be going to chemotherapy [Monday] and I don’t think I can afford it. I know I can’t afford it. I would have to sell my house and use up every savings I had.” On a Friday, the last possible day, Anthem told her the continuity of care request had been approved. Her doctors gave her the scheduled chemotherapy the following Monday.

But the nightmare wasn’t over. Anthem assigned her a new primary care doctor an hour away who would have to learn about her and her treatment regimen.

“The stress level was unbelievable for me,” Sinanian said.

In past years, such insurer vs. hospital system conflicts over reimbursement rates typically would be resolved before termination of a deal. But recently more contracts have lapsed, sending anxious patients into limbo on whether to stay with a medical provider but face higher costs.

Wellstar Health System, based in Marietta, has been out of network for UnitedHealthcare members since early October. That has affected about 80,000 patients, Wellstar said Friday. All of Cobb County’s hospitals are Wellstar facilities.

Health care experts reviewing the Northside/Anthem dispute say the two sides need each other and will eventually work out a deal.

Anthem is the metro Atlanta market’s heavyweight health insurer, while Northside’s system includes an…