19,000 Polyclinic, Everett Clinic patients face in-network insurance loss

19,000 Polyclinic, Everett Clinic patients face in-network insurance loss
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Thousands of patients of The Polyclinic and The Everett Clinic could soon have to find new medical providers or face higher rates, if the clinics’ owner and a major health insurer can’t agree on a new contract within the month.

While negotiations remain ongoing, the contracts between the two physicians’ groups and Regence BlueShield, a health insurer founded in Tacoma and based in Portland, are set to expire Dec. 19.

If the contracts expire without a resolution, patients with a Regence plan will no longer be able to pay in-network rates with The Polyclinic or The Everett Clinic, so anyone who continues to receive care from either will likely have to pay higher, out- of-network rates.

Patients who will likely be most affected are those in King, Pierce, Snohomish and Whatcom counties. The Polyclinic also has locations in Chelan County.

Regence notified its nearly 19,000 affected Polyclinic and Everett Clinic members of the change earlier this month, saying in a letter that Optum, the parent company of the groups, left its provider network after “insisting on an unprecedented increase in what we pay them for your care.”

Optum asked for an increase of about 14.75% in negotiated rates, The (Everett) Herald reported, though the company hasn’t confirmed the figure. A spokesperson for the company did not respond to several other questions about how the change might affect patients.

Optum is a subsidiary of Minneapolis-based health care giant UnitedHealth Group. It bought The Polyclinic, which started as a local physicians’ group more than 100 years ago, and The Everett Clinic in 2019. Both still serve much of the Puget Sound region.

“Supporting our patients with compassionate, quality care is our highest priority,” The Polyclinic and The Everett Clinic said in a statement. “We remain hopeful that we will reach an agreement with Regence so patients will have continued access to their trusted Polyclinic and Everett Clinic doctors and care teams.”

Regence, meanwhile, has said it’s “disappointed” that Optum plans to remove its local clinics from its provider network.

“Our premiums are based on what we expect care to cost,” the insurance company said in a statement Monday. “When providers demand unsustainable rate increases to provide care, our members and customers pay more out of pocket.”

Patients with some conditions might be able to continue network treatment for a short time, including those seeing a provider for a “serious” or “complex” condition, those benefiting from inpatient care, those who are pregnant and are seeing a provider for pregnancy- related care and those who are terminally ill, according to the state’s Health Care Authority.

“Our top priority is ensuring our members have access to high-quality, affordable health care,” the Regence statement said. “We are a tax-paying nonprofit founded in Tacoma more than 100 years ago and our commitment has always been to make care better for Washingtonians.”

For those looking for a new provider, UW Medicine, Virginia Mason Franciscan Health, Providence Swedish and Overlake Medical Center in King County are in the Regence network. MultiCare, Providence Medical Group and Western WA Medical Group in Snohomish and Pierce counties are also in-network.

The Polyclinic was founded in 1917 by six Seattle physicians, and has grown to become one of the largest multispecialty physician groups in the Greater Seattle area. Its now 200-plus physicians represent most medical specialties, and work out of more than 12 locations around the Puget Sound area.

The Everett Clinic began in Everett in 1924, and was acquired by DaVita Medical Group in 2016. In late 2017, DaVita Medical Group agreed to sell the group and other practices to UnitedHealth.

Information from The Seattle Times archives was used in this article.

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