Premera boots Providence from network for small-business plans

Small businesses in Spokane County that choose Premera Blue Cross for their employee health plans won’t have access to the Providence health care system next year.

The same provider network Premera created for individual health insurance policies also will be used for the small-group plans it sells to employers with fewer than 50 employees. That network does not include Providence, Spokane’s largest health care system.

Premera’s network instead uses the Rockwood Health System, which includes Deaconess and Valley hospitals and the large Rockwood Clinic physician network. Premera customers get fully covered care from Providence only if a particular service is not available from Rockwood.

Premera’s network change for small-business plans takes effect in 2014 but may not affect consumers until later in the year; small-business plans renew on policy anniversary dates, which could fall anywhere from January to December.

Premera said excluding Providence is a way to control the cost of insurance rates.

Yet this might prove controversial among consumers who prefer or need the services of Providence Sacred Heart Medical Center, Providence Holy Family Hospital and the Providence system’s 500 Spokane County physicians.

Eric Earling, Premera’s director of corporate communications, said Premera’s decision to remove Providence from its Spokane County network results from the “highly competitive” market for health coverage, and the concern Premera’s small-business customers have expressed about cost control.

By using the Rockwood-Deaconess-Valley network, Earling said, Premera has made itself one of the “most affordable” plans in the small-group market for 2014. To increase the savings, Earling said, Premera will offer small employers a wellness program that can reduce rates by another 7.5 percent.

Meanwhile, Premera’s leading competitors plan to offer Providence in their small-business coverage networks. Group Health has a long-standing relationship with Providence. Regence Blue Shield, which sells small-business insurance under its Asuris brand, also considers Providence to be in-network (although Regence’s individual insurance, sold under its Bridgespan brand, excludes Providence).

Premera will continue its relationship with Providence in other market segments:

• In some communities such as Olympia, where Providence operates the primary hospital, Providence will remain in-network, Earling said.

• In the Medicare Advantage plans that Premera will begin to sell for 2014, Providence is in-network even for Spokane County. Earling said the demographics of Medicare are different, which accounts for Premera accepting Providence for Medicare Advantage but not for individual or small-group coverage. Also, Medicare Advantage plans apply more managed-care techniques than are used in the fee-for-service model featured in the individual and small-group markets, he said.