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HealthCare Checkup

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

August 21, 2014 at 4:09 PM

Seattle Children’s and BridgeSpan still at odds over network

Seattle Children’s is pushing on with its case against the Office of the Insurance Commissioner, contending it illegally approved BridgeSpan Health’s 2014 individual plans for sale in Healthplanfinder, Washington’s online exchange marketplace.

BridgeSpan, an affiliate of Regence BlueShield, did not include Seattle Children’s in its provider network. Children’s, in briefs filed with the state’s hearings office, argued that an insurer cannot meet state and federal pediatric coverage requirements without its network including Seattle Children’s and its specialists.

Sunday, Children’s settled with Premera Blue Cross, which was also included in its case. The hearing, which was scheduled to begin the next morning, was delayed to Thursday, and many expected that BridgeSpan and Children’s would also reach a deal.

But on Thursday, Michael Madden, the attorney for Children’s, asked for a new hearing date. The matter is now scheduled to be heard Nov. 3.

“It’s turned into a much more complex issue,” said Insurance Commissioner Mike Kreidler. “It just shows you how complex and complicated contracting is.”

Kreidler said he’s still hopeful the two will come to an agreement. But the bigger issues still loom, he said, including how to ensure the financial stability of hospitals and medical centers that provide specialized care, conduct research, or serve a large number of patients insured by Medicaid. All of those descriptions apply to Children’s.

Hospitals can no longer expect to shift costs of research or patient care to policyholders of private insurance plans, Kreidler said, and publicly funded programs, such as Medicaid, must reimburse providers on par with other insurance plans. “Public programs have to carry their own weight,” he said.

The case concerns plans already sold for this year, but the network adequacy issues may affect health plans going forward. Although Kreidler’s office has enacted new network adequacy rules, they don’t require an insurer to include specific hospitals.

BridgeSpan, which sold only plans on the exchange, was a relatively small player in the individual health-insurance market in 2014. But its affiliate, Regence, has submitted many more plans for review for 2015.



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