Seattle Children's originally filed a lawsuit in October targeting insurers that excluded Seattle Children's from their networks. The not-for-profit provider argued that it provides unique services, such as pediatric cancer care, that are unavailable elsewhere.
In response, Coordinated Care Health and Molina Healthcare agreed to add the medical system to their networks. Talks continue with another insurer, BridgeSpan Health, an affiliate of Regence Blue Shield, according to Seattle Children's. The complaint is scheduled to be heard before an administrative law judge this week.
Premera Blue Cross and its subsidiary, LifeWise Health Plan of Washington, were the most popular options during the initial open-enrollment period. Combined, they captured roughly 60% of the individual market on the exchange in 2014. Coordinated Care enrolled just more than 26,000 individuals, while BridgeSpan attracted less than 3,000 customers.
The dispute has been among the highest-profile dustups in the country over provider networks since the exchanges launched last October. Many insurers are offering plans with narrow networks in an effort to contain costs, prompting concerns that customers will not have sufficient access to care. An analysis by McKinsey & Co. found that roughly half of all 2014 exchange plans offered narrow networks as defined by providing access to less than 70% of hospitals in a market.
In April, Washington Insurance Commissioner Mike Kriedler issued new rules addressing network adequacy. They bolstered requirements for providing access to psychiatric care and coverage in low-income areas. The state's policies had not been updated in a decade.
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