UPDATE: Effective January 1, 2022, Wellstar Hospital system in out of network on all UnitedHealthcare plans. If this affects you, keep reading.
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: