Confluence says it's dropping Premera | 36,000 in NCW would be affected

Wenatchee World, The (WA)

Aug. 5—WENATCHEE — Over 36,000 patients with Premera Blue Cross health insurance will be considered out-of-network with Confluence Health on Feb. 1, 2022, unless the two sides settle a price dispute before then.

Confluence Health began negotiations back in April by informing Premera that they would not renew their contract ending on Jan. 31, 2022, due to disagreements about Premera's pay rate, according to Andrew Canning, Confluence Health spokesperson.

Health insurance contracts typically last between two to three years, according to Dr. Peter Rutherford, Confluence Health CEO.

And after months of negotiations, there was no real progress, Canning said. "It's gotten to the point where it's clear that a deal is not likely," he said.

Premera, on the other hand, does not believe that negotiations are at an impasse, according to David Condon, Premera vice president of Eastern Washington.

"We still have quite a ways on the runway, and we really do believe that we can come to an agreement and want Confluence to come back to the table," Condon said. "It's in the best interest of our members and for the community to come back and engage in good-faith negotiations and resolve these issues."

Confluence Health says the issue is that Premera refuses to a pay rate consistent with other commercial insurance payers in the market.

"We are committed first and foremost to treating every patient who comes through our door needing care regardless of what insurance they have or if they can even pay their bill at all," said Dr. Douglas Wilson, Confluence Health CEO-elect. "We have a responsibility to our region to only accept a deal from an insurance company that has terms that allow us to continue to support our mission.

Confluence Health is not allowed to discuss any details of the contract, but Premera is the outlier among the many commercial insurers Confluence Health works with, according to Wilson.

"Premera is far apart from the needs we have and the good relationships we have with other (insurance companies)" Wilson said. "There's no evidence that Premera has any interest in working with us on that."

Condon said he does think Premera is paying its fair share to Confluence Health.

In 2020, Premera paid Confluence Health $167 million in claims, up from $160 million in 2019, according to Condon. The increase is attributed to rising hospital costs, said Courtney Wallace, a Premera spokesperson.

If Confluence Health does not renew the contract, more than 36,000 patients across North Central Washington will be "out-of-network" which could mean higher deductibles and other fees for patients.

These Premera-affiliated health insurance providers will also be "out-of-network" or affected in some way starting Feb. 1, 2022: LifeWise, Blue Cross Blue Shield, Regence Blue Shield, and Uniform Medical Plan.

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