Insurance News Updates Archives

October 12, 2021, UnitedHealthcare has confirmed Wellstar Health System in-network access has been extended to December 31, 2021. Wellstar’s contract with UnitedHealthcare ended October 3, 2021, and negotiations are ongoing.


As of 10/22/2021, for those of you in Georgia on UnitedHealthcare (UHC including AARP branded) who use the Wellstar system, the negotiations are not going well.

So, here’s what you need to do to be prepared:

  • Know if you have a Medicare Supplement or a Medicare Advantage HMO (in-network access only) or PPO (in and out-of-network option)
  • If you have a Medicare Advantage HMO, you will NOT be covered as of January 1, 2022. You have until December 7 to make a plan change.
  • If you have a Medicare Advantage PPO, you WILL have out-of-network access to your Wellstar doctors. You WILL pay the out-of-network copays/coinsurance. You may have to “educate” the person at the front desk if they say they don’t take UHC. If this happens, politely tell them they need to run your insurance claim as “out-of-network”. If they insist they do not take UHC, tell them that is the point of “out-of-network” and bill it as such. If reasoning fails because they do not understand insurance, call the number on the back of your insurance card or call me if I’m your agent.
  • If you have a Medicare Supplement, you are not affected. You may continue to see any doctor you choose who accepts Medicare assignment. If you run across the front desk person or billing person who insists they know better, call the number on the back of your card or call me if I’m your agent.

Please take the time to understand what type of plan you have and be prepared. Understand, you may receive resistance, at first, if proper guidance has not been given to Wellstar staff. It is an unfortunate situation that will hopefully be worked out eventually, but it looks as though this problem may linger into 2022 or longer. Of course, it may be worked out tomorrow. As I always say, knowledge is key with Medicare.

And again, in the event you have a UnitedHealthcare (including AARP branded) Medicare Advantage HMO, you WILL NOT have WellStar coverage beginning January 1, 2022. Feel free to call me if you have questions, are uncertain what coverage you have, or if you need to change your plan.

Here are a couple of links where you can read more:

Network Negotiations with Wellstar Health System | UnitedHealthcare (uhc.com)

UnitedHealthcare Agreement (wellstar.org)


The Biden Administration has had talks about cutting funding for Medicare Advantage plans in order to help fund their infrastructure package. Cutting funds to MA plans would greatly increase the cost of these plans for beneficiaries and could greatly reduce benefits.


October 12, 2021, UnitedHealthcare has confirmed Wellstar Health System in-network access has been extended to December 31, 2021. Wellstar’s contract with UnitedHealthcare ended October 3, 2021, and negotiations are ongoing.


October 8, 2021, Centers for Medicare and Medicaid has issued guidance to insurers regarding deceptive marketing practices. Statistically, 62.6 million people are enrolled in Medicare and marketing to this group is rampant with fraud. At the heart of this fraud are commercials and call centers. The commercials feature well known spokepersons who promise “free benefits” not availble for most people and play upon fears. Additionally, phone calls and door knockers are included in this group. It remains to be seen when changes will be occur.


In Georgia, Wellstar Health Systems may be out of network for UnitedHealthcare Medicare Advantage Plans effective October 3, 2021. Contract negotiations are ongoing. Wellstar Health Systems is seeking a reimbursement increase of over 20%, making their services 50% higher than other hospitals in Georgia.


A new infusion therapy drug purported to treat mild Alzheimer’s, has been rushed through FDA approval despite serious concerns about its effectiveness as well as side effect including swelling and brain bleeding during clinical trials. If ineffective, this infusion therapy would cost thousands in out-of-pocket costs for Medicare Advantage members.


Bipartisan legislation that would establish electronic prior authorization for Medicare Advantage plans has been introduced to House of Representatives. Improving Seniors’ Timely Access to Care Act (H.R. 3107) would establish electronic prior authorization for Medicare Advantage plans allowing for real-time decisions on tests and services commonly approved. Electronic PA would improve patient access to timely care and reduce paperwork and appeals.


Medicare recipients in Georgia, Alabama, Florida, North Carolina, Tennessee and Virginia may be eligible for a Special Election to make a plan change. Please contact us for further information.


Biden Adminsitration has approved a Special Enrollment Period for individual health plans. If you missed the annual enrollment, you now have until August 15, 2021, to choose a plan.


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