Seattle Children's Hospital has reached an agreement with one of the insurers that had originally excluded it from plans offered on Washington state's health insurance exchange.
The settlement with Molina Healthcare adds Seattle Children's as an in-network provider, according to a Seattle Children's spokeswoman.
The move comes as Seattle Children's has taken an additional step in its lawsuit against the state office of the insurance commissioner. It is asking the agency to reverse approval (PDF) of exchange health plans that excluded Seattle Children's from their networks.
The administrative appeal, filed Tuesday, names two additional health insurers offering plans that do not include Seattle Children's. The plans are Premera Blue Cross and BridgeSpan Health Co.
In its initial lawsuit, filed Oct. 4, Seattle Children's named only two insurers: Molina and Coordinated Care Corp., because of “technical legal reasons,” the hospital said on its blog.
Eric Earling, a spokesman for Premera, said its exchange plans will cover emergency care as well as “unique services” at full benefit status. And if patients seek non-unique service from Seattle Children’s, they will be protected from balance billing and only charged the out-of-network share of the contracted rate. The provision to allow access to unique services was part of the payer’s discussions with the insurance commissioner when the exchanges plans were reviewed, Earling said.
Asked if it is still in further negotiations with Seattle Children’s, he said, “At this point, our network has been approved.”
Regence, which owns BridgeSpan, did not respond to a request for comment.
Seattle Children's appears to be the first provider in the country to file litigation challenging the narrow networks many insurers are creating for their exchange plans. But there likely will be others as the issue plays out across the country, particularly affecting higher-cost and specialty hospitals.
Seattle Children's, the only children's hospital in King County where Seattle is located, is also trying to rally its patients and families. It has set up a webpage asking them to contact Insurance Commissioner Mike Kreidler as well as the exchange's board of directors with their own stories and show support.
Follow Beth Kutscher on Twitter: @MHbkutscher