One of the most acrimonious disputes of the insurance exchange debut is coming to a close, in a testament to the market influence some providers now have.
Premera Blue Cross, the parent of Blue Cross plans in Washington, Oregon and Alaska, has reached an agreement with Seattle Children's Hospital that will make the hospital available to individual and small group plans sold on and off the state exchange.
Under the agreement, Seattle Children's Hospital and the Children's University Medical Group of physicians will be available Premera Blue Cross of Washington plan networks, without any additional premium changes in 2015.
"We are delighted that all of our members will have full access to Seattle Children's," said Rich Maturi, Premera senior VP for healthcare delivery systems, in a media statement.
"We're very pleased to move forward with an agreement that benefits the patients and families we serve," said Sandy Melzer, senior VP and chief strategy officer at Seattle Children's. "We're also pleased to announce that as a result of these successful negotiations, we will be dismissing our pending appeal with the Office of the Insurance Commissioner (OIC) as it relates to Premera."
In the first open enrollment period, only two of the seven exchange insurers available in greater Seattle, Group Health Cooperative and Community Health Plan of Washington, sold plans with Children's Hospital in-network.
That appearance of exclusion prompted Seattle Children's to file appeals against the other five insurers, including Premera's LifeWise subsidiary, on the grounds that its specialized pediatric care was unique and deserved to be included across plans.
Since then, Premera and two other insurers--Molina Healthcare and Coordinated Care--have reached an accord with Seattle Children's. A decision by rival Blue insurer BridgeSpan Health, the exchange plan of Regence Blue Shield, has yet to be reached.