Seattle Hospital Sues State Over Exclusion From Exchange Plan Networks

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Seattle Children鈥檚 Hospital filed suit Friday over the state Office of the Insurance Commissioner鈥檚 鈥渇ailure to ensure adequate network coverage鈥 in several of the health plans sold on the state鈥檚 new online insurance marketplace, called Washington Healthplanfinder.
Most health plans now being sold through the state鈥檚 new health-insurance exchange do not include Seattle Children鈥檚 as an in-network provider. As a result, families that enroll in those plans could face significantly higher cost-sharing if they seek care at Children鈥檚 than if they seek care at the plans鈥 preferred providers.
The higher cost-sharing could seriously disrupt care for families currently receiving services at Children鈥檚 and could delay new patients from getting the specialized care they need, said Dr. Sandy Melzer, the hospital鈥檚 senior vice president and chief strategy officer.
Melzer said parents may be enrolling in health plans through the exchange without realizing that Children鈥檚 is not included in the plan鈥檚 network.
鈥淭he notion that a major insurance plan is going to exclude us from their network is truly precedent-setting and represents a new level of degradation in children鈥檚 access to care,鈥 Melzer said.
Of the seven insurers offering plans in King County, only two 鈥 Group Health Cooperative and Community Health Plan of Washington 鈥 are offering plans through the exchange that include Seattle Children鈥檚 in their network.
The five in King County that do not include Children鈥檚 in their network are Premera Blue Cross, LifeWise Health Plan of Washington (a subsidiary of Premera), BridgeSpan (a subsidiary of Regence Blue Shield), Molina Healthcare and Coordinated Care.
Kaiser Foundation Health Plan of Washington, which is offering plans only in Clark and Cowlitz counties, also does not include Seattle Children鈥檚 in its network.
Children鈥檚 is asking that the OIC reverse its decision to allow Molina and Coordinated Care to sell plans on the exchange as long they do not include the hospital in their networks.
OIC spokeswoman Stephanie Marquis says the OIC takes concerns about access to care seriously. 鈥淲e are reviewing Children鈥檚 petition to see what lies at the heart of their concerns and will see how it gets resolved through the legal process,鈥 she said.