Care at several South Puget Sound emergency rooms could cost more unless one of the state’s largest insurers settles its dispute with a group of doctors.
Almost a million About 100,000 people in the state received a letter this month from Regence BlueShield. The letter warned of higher out-of-pocket costs beginning July 1 for people who visit ERs run by the Franciscan Health System and two others.
The amount of the increase is unclear. Adding to the confusion, even the effective date now is up in the air.
A Regence spokeswoman said Wednesday that there is no set date as negotiations continue.
The website for Franciscan, which is stuck in the middle of the dispute, said higher costs could begin Oct. 31. But Tuesday, a spokeswoman on behalf of the doctors group, Northwest Emergency Physicians, said higher costs could start Sept. 30.
“It just irritates me to dickens,” said Wayne Wolf, a postal worker in Federal Way who is covered by Regence. “I’m hoping people will come to their senses.”
Wolf, who in the past has made several ER visits as his wife was being treated for cancer, said people shouldn’t have to worry about higher bills during an emergency.
At the heart of the contract dispute is the doctors’ request for higher reimbursement rates for care. The increase was above what other comparable groups usually ask for, Regence spokeswoman Rachelle Cunningham said.
Regence and Northwest Emergency Physicians are continuing to work through the details in an open dialogue, said Tracy Young, spokeswoman for Team Health, a Tennessee-based company that owns NEP.
“We fully intend to work something out,” she said.
Regence sent a letter dated June 15 stating that emergency rooms staffed by NEP will have higher costs after July 1 when the contract between the parties was set to end.
The affected ERs are:
• St. Joseph Medical Center, Tacoma.
• St. Anthony Hospital, Gig Harbor.
• St. Clare Hospital, Lakewood.
• St. Francis Hospital, Federal Way.
• St. Elizabeth Hospital, Enumclaw.
• Cascade Valley Hospital, Arlington.
• Island Hospital, Anacortes.
Most of the ERs are part of the Franciscan Health System. Spokesman Gale Robinette said no patient will be denied care if the contract is terminated.
“The only reason our name is on the letter is because we contract with Northwest Emergency Physicians,” Robinette said.
MultiCare Health System also outsources its ER care, but doesn’t use Northwest Emergency Physicians.
The outsourcing of emergency room doctors is “akin to a private practice,” Marce Edwards, spokeswoman for Multicare said. These specialized groups have expertise in emergency care, she said.
If the contract ultimately is not renewed, care at those certain ERs will become out-of-network, meaning they will cost a prescribed amount more depending on a person’s coverage plan.
Wolf, the Regence client, said people facing a true emergency might not have a choice about where they go. He worries about them getting a bigger bill in the mail after they’re treated. His wife, Faye Tompkins, is a cancer survivor. He remembers long waits in the emergency room at St. Francis when she had negative reactions to chemotherapy.
“I am so thankful for excellent care,” Wolf said.
Regence said for now nothing will change.
“At this point there is not termination on the table,” Cunningham said.
“It’s very unusual that a contract would come to this point.”
Regence BlueShield said Wednesday that it wants to increase average premiums by nearly 15 percent on customers who buy coverage for themselves and their families, a week after the state insurance commissioner said the insurance company is sitting on record surpluses.
Regence BlueShield said it has asked the Office of the Insurance Commissioner to approve the increase, which would raise rates an average of 14.7 percent, though it would vary for customers depending on their plans and other factors. Company officials said the insurer expects to lose money this year.
“We understand that it’s becoming harder for individuals to afford the increasing cost of health care,” Jonathan Hensley, president of Regence BlueShield in Washington, said in a statement. “… Regence is doing our best to continue offering a comprehensive set of affordable benefits.”
If approved by Insurance Commissioner Mike Kreidler, the increase would go into effect Oct. 1 and last through Dec. 31, 2013.
Last week, Kreidler announced that Regence BlueShield and Premera Blue Cross each had surpluses of more than $1 billion, more than what the companies are required to set aside in reserves.
Kreidler argued then that the companies were building up a financial cushion that “comes at an expense for people” and noted that the cost of individual health policies in Washington more than doubled between 2005 and 2011.
Kreidler said Wednesday that even if the Regence BlueShield loses what it projects, “that’s less than half of 1 percent of the company’s $1 billion surplus.”
“In fact, Regence could continue to lose $4.5 million annually for the next 220 years and it would still have a surplus,” he said in a written statement.
Kreidler said Regence BlueCross BlueShield of Oregon had made a similar request for a 6.4 percent increase there, but after the state’s review and objections, it withdrew the request Wednesday.
“Any future rate request will face the same thorough scrutiny,” Kreidler said.
Kreidler has 60 days to consider Regence BlueShield’s request.
In a statement last week, Regence BlueShield said its capital reserves provide a safety net for members against unknown risks and costs as well as money needed to finance initiatives. Using such money to buy down rates promotes a false impression of reducing health care costs; the cost of health insurance goes up because medical costs go up, the company said.
Kreidler has been pushing to change state law so the insurance commissioner can take into account the size of insurers’ surpluses when considering whether to approve or deny premium rate hikes.
karen.miller@thenewstribune.com 253-597-8876 @karen_e_miller
The Associated Press contributed to this report
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