FREQUENTLY ASKED QUESTIONS
Does this affect TRMC’s acceptance of United Healthcare Commercial plans?
No. Tift Regional will remain an in-network provider for the United commercial plans. This change is only for United’s Medicare Advantage enrollees.
Will Tift Regional Medical Center, including Southwell Medical, (collectively “TRMC”), still provide services to United Healthcare of Georgia Medicare Advantage (“United”) enrollees?
Yes, but TRMC will be considered an out-of-network provider.
What does it mean to be an out-of-network provider?
Many of TRMC’s patients have experienced challenges with United’s network participation, even though TRMC made countless attempts to follow the necessary enrollment steps. Over the past two years, a majority of TRMC’s Physicians and other Providers have remained out-of-network due to United’s inability to enroll these providers. Out-of-network providers are not contracted with a particular health insurance plan for negotiated rates. TRMC’s providers have provided (and will continue to provide) services to these members, regardless of their network participation status.
Will this impact the out-of-pocket expense of United enrollees, especially the elderly and retirees?
Depending on the individual’s plan, many United Medicare Advantage enrollees may not recognize a significant change in the individual’s share of the cost of healthcare services provided by out-of-network providers. For example, the United Healthcare State Benefit Health Plan (and most other United Medicare Advantage Plans) note in their letter that the member’s “share of the cost (i.e. co-pays/coinsurance) will be the same as if they were part of the network”.
How will this termination affect TRMC’s physician clinics?
Until at least December 3, 2024, the physicians who are currently in the United network will remain in network. It is our hope that our physician clinics, including our rural health clinics, will be able to participate in the United Medicare Advantage program beyond that date.
Why did TRMC terminate the agreement with United?
This decision comes after over two years of unresolved issues with United regarding disputed payments and network participation under the United Medicare Advantage program.
What are the options for patients affected by this change?
- Visit www.medicare.gov to search for available plans based on your 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.
Can United subscribers change to another Medicare Advantage plan that includes TRMC as an in-network provider?
Yes. The open enrollment period for Medicare begins on October 15th and ends on December 7th .
TRMC accepts the following Medicare Advantage insurance plans: Aetna; Anthem Blue Cross Blue Shield; Clear Spring Health; Clover Health; Humana; Pruitt Health Premier; and WellCare. The list of insurance plans accepted by TRMC is also available on www.mysouthwell.com/billing-and-insurance-information/.
Why didn’t TRMC wait until open enrollment to terminate the agreement with United?
Unfortunately, United’s hospital agreement with TRMC was up for renewal on April 1, 2024. Tift and United executed two extensions while negotiations continued. Those extensions will run out on May 31, 2024 at midnight, and no additional extensions were offered.
As TRMC has done over the past two years, TRMC will continue to support patients who are experiencing any issues with United’s network participation challenges, including assistance with any billing issues.
