Surgeon Calls on Community to Support Augusta Health

Posted: Updated:

A surgeon at Augusta Health is calling out Anthem Insurance for putting profit above patient care in its contract dispute with the hospital.

Negotiations between Anthem and Augusta Health failed to reach a resolution before the contract expired Sunday, December 31.

Augusta Health is now "out-of-network" for people covered by Anthem, meaning they may have to pay more for procedures at the hospital or choose to seek care somewhere else.

Dr. Tom Pereles is part of a private practice, Shenandoah Valley Orthopedics, housed in Augusta Health. It has a separate contract with Anthem.

So, right now, insurance covers his patients when they see a doctor in the office. But they'll be “out-of-network” if they need surgery next door in the hospital.

Augusta Health's contract dispute with Anthem centers around the rate it reimburses the hospital.

Augusta Health wants a 7.5 percent increase.

Pereles says that raise is needed for the nonprofit hospital's survival.

“Augusta Health provides a lot of charity care,” says Dr. Pereles. “It provides a higher percentage of its services to Medicaid than these other community hospitals in the region, and so it needs to get paid at least close to what the other hospitals are getting paid for the same services. Otherwise, it can't survive."

Pereles posted his thoughts on the contract dispute on Facebook.

It's been shared more than 1,000 times with hundreds of comments.

He's encouraging the community to support Augusta Health.

A hospital spokeswoman says there's no update on the negotiations with Anthem.

The latest discussions happened just before the contract expired Sunday night.