Washington state's Premera Blue Cross members have two weeks until a contract with MultiCare Health Systems expires, removing their access to around 1,000 health care providers statewide.
While the two not-for-profit healthcare organizations have negotiated for months, Premera's website says MultiCare entered the process with a termination notice.
The Center Square reached out to MultiCare for an interview, but Kevin Maloney, media relations manager for MultiCare's Inland Northwest region, responded with an email stating that the organization is participating in negotiations but that Premera needs to pay its fair share.
"Since 2019, Premera has reimbursed MultiCare well below the rate of inflation," Maloney wrote in the email. "This is not sustainable and jeopardizes access to 1,000 health care providers and multiple hospitals, urgent cares, and health clinics across the state."
David Condon, Premera Blue Cross' vice president of Eastern Washington, said the rate being paid is what MultiCare agreed to during the last negotiations. Premera's priority is remaining affordable to its members and competitive in the market.
He said Premera recognizes that inflation is outpacing reimbursement rates, but the negotiations aim to reach an agreement, which requires both parties. Condon was vague in describing the current status of an agreement, noting that the process is ongoing.
According to the company's website, Premera Blue Cross members with individual plans, University of Washington student insurance and Medicare Advantage Plans will no longer have access to MultiCare facilities under in-network prices starting June 1 if the two fail to reach an agreement.
Impacted access would include all MultiCare clinics and facilities in King, Pierce, South King, Spokane, Thurston and Yakima counties, which, according to Premera's website, include:
However, it would not affect members' coverage through Premera's Medicare Supplement plan or the Health Maintenance Organization plan with its Sherwood HMO network.
"Our guiding principle is to provide access to quality care, which MultiCare absolutely is, but then also at an affordable price," Condon said.
Like many businesses throughout the state, MultiCare is under significant financial pressures, he said. But by raising rates to accommodate MultiCare, the companies that pay Premera to insure their employees also end up paying more.
Condon compared the situation to a balancing act. He said that Premera wants to meet MultiCare's needs but must also ensure its members' costs remain predictable.
"They've been pretty public about what their costs are," Condon said. "Now the issue is what's fair for them and what's fair for our members who have to pay that price."
He said that if negotiations fail, Premera members can still receive emergency care at MultiCare facilities, which is always covered at the in-network cost. Members who are pregnant or receiving active treatment can also apply for extended in-network access to avoid any lapse in coverage.
