Insurance negotiation letter concerns patients one week before contracts end

The clock is ticking for 1.6 million people in Washington State to maintain access to their health care providers as they negotiate with their insurance company.

Providence Swedish and PacMed are in contract negotiations with Regence BlueShield for a contract that will expire on April 1, meaning providers in those 28 hospitals across the state will become out-of-network, costing patients up to 40% more in out-of-pocket costs. A legally required letter was sent from Regence to its members warning of the potential contract impasse.

“I was pretty shocked by that,” said Andrea John-Smith, a client of Regence BlueShield who goes to a PacMed clinic. “The scale is what really struck me.”

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John-Smith understands it’s a required letter and a standard part of negotiations, but was still caught off guard by the wording of it, especially as the April 1 deadline is less than a week away.

“I’ve experienced what it’s like to have to start up and build a relationship with someone that doesn’t know you and what it takes, and the kind of trust that you need in order to have, you know, intimate conversations about your health. So it worries me,” she said.

For Olivia Vigrabs, the letter created a slight panic. She’s pregnant, due at the end of May, and because of her high blood pressure and gestational diabetes, she has doctor appointments scheduled throughout her term.

“I have tons of doctor’s appointments almost every week, so getting those all scheduled in the first place has been stressful. Now, if they did drop it, I would have to reschedule all that stuff,” Vigrabs said. “The idea of having to repeat all this stuff and go to a new provider is just awful.”

The Washington State Office of the Insurance Commissioner says negotiations are common between health care providers and hospitals, and they’re often resolved before the contract expires.

“The vast majority of these times, these contract negotiations are resolved,” said Aaron VanTuyl, a spokesperson with the Washington Office of the Insurance Commissioner.

Whether common or required, the tone of the letter struck both Vigrabs and John-Smith.

“It seems like a kind of underhanded bit of negotiation,” Vigrabs said. “Just wanting us to put the pressure on.”

Regence BlueShield says Providence Swedish canceled the contract, requiring the negotiations to take place. When asked, Providence Swedish did not deny that assertion.

“We continue to negotiate with Regence and believe that we can forge equitable contracts to avoid any disruption to their members’ ability to receive care at Providence Swedish hospitals and clinics,” a Providence spokesperson said in a statement.

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John-Smith says that when she’s reviewed her statements, what is paid to providers seems “actually really low.” That, combined with how she says Regence has scaled back her coverage, makes her understand Providence Swedish’s call to renegotiate.

“I’m always experiencing my insurance provider as a ‘No. No, you can’t have what you need,’” John-Smith said. “My providers are out there advocating and spending time they’re not compensated for, filling out appeals and things like that. So there’s definitely a sense of loyalty I have to the folks who’ve actually tried to help me.”

A statement from Regence BlueShield says, “Our premiums are based on what we expect care to cost. If providers demand more money, our members and customers will pay more, and as stewards of our members’ health care dollars, it is imperative we negotiate on their behalf.”

Statements from both Regence BlueShield and Providence Swedish say they are each working hard on an agreement before the April 1 deadline.