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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

April 23, 2014 at 7:20 PM

Coordinated Care adds Seattle Children’s to network

Coordinated Care Health, whose “Ambetter” plans are sold through the Washington Healthplanfinder, has added Seattle Children’s to its network of providers.

The insurer took a lot of heat last year for not including Seattle Children’s, which sued last year to force the insurance commissioner to require plans to include Children’s, arguing that it has unique services not available elsewhere, such as acute cancer care, inpatient pediatric rehabilitation, level IV neonatal intensive care and heart, liver and intestinal transplantation.  Molina Healthcare of Washington, which also had not included Children’s in its network, later reversed its position.

In a statement Wednesday, Seattle Children’s said: “This is great news for Washington families who are covered by Ambetter, Coordinated Care’s plan on Washington’s Health Benefit Exchange, because it will allow them to access Seattle Children’s Hospital at the in-network rate in June.”

The Office of the Insurance Commissioner (OIC) had originally refused to approve Coordinated Care and Molina’s plans to be offered inside the Washington exchange’s Healthplanfinder, saying they had not demonstrated an adequate network, among other things. Later, under pressure to give consumers more choices among plans offered in the exchange, the OIC approved both insurers’ plans.

After that, Children’s sued in King County Superior Court, asking for a court review of orders issued by OIC. It argued that the insurers did not meet current network adequacy requirements.

That lawsuit was dismissed last week, because both named insurers had contracted with Children’s, but the medical center’s legal proceedings at the OIC continue. A decision in the administrative appeal, before an administrative law judge, can be appealed to Superior Court.

Thursday, Seattle Children’s officials, in a statement, added: “The dismissal of the lawsuit does not mean that we have abandoned our legal fight against the OIC.” The ongoing administrative appeal, the medical center said, asks OIC to reverse its decision to approve plans from Premera Blue Cross and BridgeSpan Health Company, which do not include Children’s in their networks.

 

 

Comments | Topics: Coordinated Care, Healthplanfinder, network adequacy

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