Over 10,000 Premera-insured MultiCare patients in Spokane at risk of losing in-network care at the end of May

Thousands of patients in Spokane are at risk of losing access to their MultiCare primary physician if they are covered by Premera Blue Cross insurance.

Negotiations to keep Premera-insured patients in-network at Rockwood Clinics and Deaconess and Valley Hospitals have stalled ahead of a deadline at the end of May.

At issue in the dispute is the amount Premera is willing to pay out to MultiCare for the hospital to care for those covered by their health insurance plans. The hospital system claims inflation and increased health care costs in recent years require a much larger payout..

“We need Premera to reimburse us adequately so that we can continue to provide great care with the breadth and depth that we have been doing in the state. But there’s been an increase in cost of care,” MultiCare Inland Northwest region CEO Alex Jackson said.

Under the current contract with Premera, payments to MultiCare increase 3% a year. But health care costs for the hospital system have increased 50% over the past five years, Jackson claimed – blaming labor costs and supply chain issues.

According to Premera, MultiCare has “requested double-digit increases,” which is something Premera “just can’t afford.”

“We really are now looking at balancing our customers’ dollars with access to care, and we realize there has been impacts to MultiCare’s costs, and we want to fairly compensate them, but we also have a keen eye on the cost to our members,” Premera Vice President David Condon said.

The current agreement between the two nonprofit companies expires May 31. Should a new contract not be reached, all Premera-insured MultiCare patients will become out-of-network patients and either have to find a new doctor or pay large out-of-pocket costs. According to Premera, approximately 103,000 individuals would be affected statewide, and 11,000 of their members just in Spokane.

Should MultiCare become out of network, Premera-insured patients will still be covered for emergency care at MultiCare emergency rooms. Some treatment for a covered series, complex or chronic condition may still be covered at MultiCare locations.

“You may be able to continue your care with those providers or facilities at the current in-network benefit level for a specific period of time. If you have concerns, contact customer service,” reads a Premera letter sent earlier this week to members who use MultiCare. Examples of conditions that may still be covered include pregnancy and scheduled nonelective surgeries.

Medicare supplement and primary HMO plans are also not affected, should MultiCare fall out of network. But any Medicare Advantage, individual plans or commercial would not be covered.

If an agreement is not reached, Spokane patients should seek primary care at Kinwell Clinics, Condon said. The system of clinics will still be covered by Premera Blue Cross plans.

Despite the large gulf between the parties, both said they were confident a deal would be hashed out before the end of the month.

“We want our patients in the community to know that MultiCare is really prioritizing these negotiations. They will allow us to provide care for the primary patients in our communities across the state that are sustainable,” Jackson said. “I’m really proud of the quality care the breadth and depth of our services.”

“We’re committed to getting to an agreement. Absolutely,” Condon said, calling the alternative “very disruptive to our members.”

Even if coverage does lapse at the end of the month, both sides also committed to continue negotiations until a deal is reached.