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After two years of unresolved disputes and multiple contract extensions, Tift Regional Medical Center/Southwell Medical (collectively “TRMC”) announced that its in-network participation agreement with the United Healthcare Medicare Advantage (“UHCMA”) plan will expire on October 31, 2024 and will not be renewed by TRMC. This does not affect traditional Medicare or United Healthcare’s commercial plans.
“TRMC is not able to renew the agreement because payments from UHCMA are delayed in many cases and do not appropriately cover the true cost of care,” said Christopher Dorman, TRMC President/CEO. “We rely on fair, timely payments to provide the high-quality services expected by our patients and the community. Basically, UHCMA is paying what they want to pay and when they want to pay without regard to what is in the agreement.”
Dorman noted that TRMC is not alone and that some of the other hospital systems within the region do not have a network participation agreement with UHCMA for the same reasons as TRMC.
“Unlike for-profit United Healthcare, TRMC has no stockholders—we just have stakeholders,” Dorman said. “TRMC is a nonprofit hospital which negotiated contract terms in good faith on behalf of the communities we serve.”
Dorman said TRMC is notifying the public now because the open enrollment period for Medicare begins on October 15, 2024 and ends on December 7, 2024.
“The open enrollment period is an opportunity for UCHMA enrollees to transfer to a Medicare Advantage plan that has a network participation agreement with TRMC,” he stated. “These Medicare Advantage plans include Aetna, Anthem Blue Cross Blue Shield, Clear Spring Health, Clover Health, Humana, Pruitt Health Premier, and WellCare.”
Other options include:
· Visit medicare.gov to search for available plans based on zip code and other criteria.
· Call 1-800-MEDICARE for guidance from a representative with the federal Medicare operation.
· Contact the Georgia State Health Insurance Assistance Program at 866-552-4464, option 4, for free assistance with reviewing Medicare enrollment options.
· Call the phone number on the back of your insurance card for more information.
TRMC will also be scheduling community forums soon to provide assistance to patients and to answer any questions. More information will follow.
“It is important to note that TRMC will continue to provide services to UHCMA enrollees as an out-of-network provider,” Dorman said. “In network means we have contracted rates with the Medicare Advantage plan. In many cases, deductibles for patients under an out-of-network Medicare Advantage plan are the same as an in-network plan.”
For further assistance, patients can call a special TRMC Patient Financial Services hotline at 229-353-7072. A list of frequently asked questions can also be found at www.MySouthwell.com.
“We understand that changes like this may cause concern or inconvenience, and we are committed to assisting our patients throughout this transition,” said Dorman. “We thank our patients for their continued trust in TRMC.”
