ATLANTA — An initiative by insurance companies to reduce high-cost doctor visits could cause physicians to abandon private practice and work for big hospital chains, independent practitioners are warning.
They say the trend could drive up patient costs.
Cigna implemented a policy last week to flag bills that appear to be too high. The insurance company may reduce payouts by one billing level “when the encounter criteria on the claim does not support the higher-level” payment code, the new policy says.
Dr. David Eagle, vice president of the American Independent Medical Practice Association (AIMPA), expects the new cost containment approach to erode income for private doctors, with long-term consequences for their patients.
Providers will be able to appeal downgraded billing claims by sending detailed medical records, but it is a labor-intensive process, said Eagle, a blood and cancer specialist in New York. He suspects such “downcoding” decisions will be made using algorithms that rapidly assess claim forms containing few details. Small doctors’ offices won’t be able to keep pace, he said. “Basically, they’re going to be underpaying the doctors based on information on the claim form.”
Cigna said only about 1% of providers in its network will be affected by the new policy, which “aims to reduce overbilling.” A one-level claim downcode will result in an average $50 reduction in payment, the company said in a written statement.
But $50 per visit adds up for a practice that runs on thin margins, said Dr. Bradley Sumrall, a blood and cancer specialist in Macon.
“I see 25, 30 patients a day. If you take out fifty bucks a patient, that’s $1,500 a day. That’s several employees,” he said. “We run on thin margins. We need money coming back to us in a timely manner, and anything that erodes that or slows it down puts more pressure on us to stay afloat.”
Aetna has had a similar downcoding policy for at least a couple of years. A spokesperson responded in writing that the company is obliged to monitor payment claims for its clients and members and to prevent fraud, waste, and abuse of Medicare and Medicaid.
Independent providers worry that such cost-saving policies will erode their income and drive more of them to work under the umbrella of big businesses with robust billing departments. Independent doctors’ billing offices typically lack the firepower to push back as effectively as a hospital’s or a health system’s, Eagle said.
The proportion of physicians who left independent practice for employment under hospitals and health systems doubled over the past dozen years, rising to 55% in 2024, according to a study by the Physicians Advocacy Institute.
Independent doctors say downcoding policies could accelerate that trend, with long-term consequences for patient costs.
Dr. Elizabeth Burns, an Atlanta dermatologist, said she understands the motivation of the insurance companies, adding that it conflicts with a provider’s mission.
“They’re trying to save money. That’s their main objective,” she said. “The majority of doctors, their main objective is for the patient to get the best care.”
Some “outlier” physicians might overbill and should be audited, Burns said. “But it shouldn’t affect all the other people who are correctly coding and whose medical visit notes justify the codes that they’re submitting.”
Eagle predicted that this money-saving maneuver will drive up costs for patients.
He said he was previously in an oncology group in North Carolina that joined a hospital system to cope with expanding administrative burdens and decreasing reimbursements. His patients then encountered new facility fees and increased co-pays, he said.
“So, I’ve lived it. This does have an impact when physicians move from the private setting to the independent setting,” Eagle said. “Everything else was the same. I was the same doctor, it was the same patient, they came to the same building, they got the same service. And many of them, because of the facility fees, paid a lot more for their co-pays. And some of my patients just said, ‘Look, I can’t keep seeing you anymore.’ So, it can have an impact, no doubt about it. All of a sudden, that doctor that you’re used to seeing is now in a health system.”
ATLANTA — The mother of a woman who blamed Georgia’s abortion law for the death of her daughter is backing former state Sen. Jason Esteves in next year’s primary campaign for governor.
Shanette Williams said Thursday that she trusts the Atlanta Democrat to overturn the law that bans abortion once a fetal heartbeat is detected.
“We need a champion for women in the governor’s office now more than ever, and it’s clear that Jason is the right person for the job,” Williams said in a statement released by the Esteves campaign.
The Republican-led law passed in 2019. It took effect after the U.S. Supreme Court ruled in 2022 that the Constitution does not guarantee a right to abortion, reversing a decades-old precedent that said it did.
Pregnant women have subsequently been denied medical care in Georgia during miscarriages because of uncertainty among doctors about whether they could face prosecution for it.
Williams’ daughter, Amber Nicole Thurman, died after doctors delayed removing remnants of her fetus after she self-aborted with pills.
Williams said at a legislative hearing in June that her daughter died of sepsis, which she said could have been avoided with a 3-minute procedure that she said doctors withheld for 20 hours.
“She didn’t just die. She was murdered by the people who took the oath to do no harm,” Williams said at the hearing.
Democrats say the law is “vague” and creates an “air of criminality” around women who miscarry or need an abortion for a medical reason. Esteves said he would fight to overturn it if elected.
That is not an unusual position for a Democrat, but Esteves will be looking for any edge in what has become a free for all for governor.
Leading political figures in the Democratic primary include former Atlanta mayor Keisha Lance Bottoms; former DeKalb County CEO and state labor commissioner Michael Thurmond; and former Lt. Gov. Geoff Duncan, who recently switched from the Republican party.
Whoever emerges from the Democratic primary will face the winner of the Republican nomination, which includes Lt. Gov. Burt Jones, Attorney General Chris Carr, and Secretary of State Brad Raffensperger.
Peter Hubbard, the Democrat running for Public Service Commission District 3, speaks with reporters after an Atlanta Press Club debate at the WABE studios in Atlanta, where he was the only PSC candidate to attend, on Wednesday, Oct. 8, 2025. (Ty Tagami/Capitol Beat)
ATLANTA — A solar power advocate who is running for a seat on Georgia’s energy regulation agency made his case without opposition Wednesday when his opponent declined to participate in a broadcasted debate.
“Why didn’t you have the courage to show up today and defend your six rate hikes in two years,” Peter Hubbard, the Democrat running to unseat Republican Fitz Johnson from the Public Service Commission, said at the Atlanta Press Club debate Wednesday. “And what will you do to lower power bills?”
The five-member PSC regulates the companies that provide consumers with electricity, natural gas and telecommunications. All five run statewide for six-year terms, but a series of events produced a race where Hubbard is competing with Johnson for an abbreviated term representing District 3 in metro Atlanta.
The odd-year election stems from an ultimately unsuccessful lawsuit that argued statewide elections for seats that technically represent a portion of the state dilute the impact of Black voters.
The lawsuit postponed PSC elections last year and in 2022.
Johnson was appointed in 2021, so this is the first year he has had to stand for election to the post.
Two other candidates are vying for the District 2 seat, which represents eastern Georgia.
Republican Tim Echols was first elected in 2010 and reelected in 2016 and would have been up for reelection in 2022 if not for the lawsuit.
Democrat Alicia Johnson wants to unseat him. She and Echols also did not participate in Wednesday’s debate, which took place in the studios of Atlanta broadcaster WABE.
Hubbard said current PSC policy will further drive up consumer electricity bills as more data centers get built. The facilities, a necessity for the development and operation of artificial intelligence, consume massive amounts of power. And Hubbard said they pay less per unit of energy than other customers.
Both of the Republican incumbent candidates have refuted such claims, saying a resolution that the all-Republican PSC approved in January forbids Georgia Power from passing on the costs to ratepayers of serving new large-load customers — including data centers.
Fitz Johnson said at a Georgia Chamber of Commerce event this summer that the new policy “absolutely strengthens the grid, puts downward pressure on the rates … so we don’t have to be worried about large loads coming here and driving up your rates.”
Echols has said the state “is poised to become the artificial intelligence capital of America” and that data centers produce local tax revenue.
The incumbents were in office when the expansion of nuclear Plant Vogtle was completed last year, seven years behind schedule and with massive cost overruns.
Vogtle’s Units 3 and 4 were the first new nuclear reactors built in America in decades.
Hubbard said the cost makes nuclear power unaffordable. He said solar power and other innovations can meet future needs at a reasonable cost.
“There are things like unlocking the value of solar, and embracing newer technologies like virtual power plants, that can allow us to accommodate the load growth that we’re seeing from data centers while also putting downward pressure on rates,” Hubbard said at his solo debate, which is being broadcasted on radio and television. “The lowest cost resource is also the most sustainable and the most reliable. Solar and battery storage will increase the reliability and lower costs for consumers in the state. So, we can have our cake and eat it too.”
The election is Nov. 4. Turnout was low in the PSC primaries this year. No other statewide candidates are on the ballot, but local offices on November ballots may draw more to the polls for a race that could affect every resident’s pocketbook.
ATLANTA – Georgia’s net tax collections rose by 1.9% last month compared to September of last year, the state Department of Revenue reported Tuesday.
The state collected $3.27 billion in September, up $60.3 million over the same month a year ago.
Monthly individual income tax receipts rose 3.2% over September 2024 as tax refunds fell 16.2% and withholding payments rose 1.7%.
Other categories were up too, the sales and use tax by 2.9% and the corporate income tax by 7.6%. Motor fuel taxes gained 1.8% and tag and title fees rose 20.8%.
The title ad valorem tax, a small category that brought in $71.7 million for the month, fell 8.5% compared to a year ago.
ATLANTA — Local health departments are giving COVID-19 shots while supplies last, with more vaccine expected to arrive next week.
The Georgia Department of Public Health began vaccinating after the Centers for Disease Control and Prevention issued new COVID-19 immunization recommendations Monday.
The CDC is recommending that most adults get vaccinated, especially those 65 and older and those who have never been vaccinated. Parents of children at least 6 months old should discuss vaccination with a healthcare provider, the federal agency said.
No prescription is required, but local health department nurses or other providers will counsel patients on the risks and benefits of vaccination, the Department of Public Health said.
Most major insurance companies will cover the cost of immunization, but the state is advising people to check with their insurers. Vaccination is covered by Medicare and Medicaid.
