Polyclinic contract negotiations extended through the week [The Seattle Times]

Dec. 20—Contract negotiations have been extended slightly between a major Washington health insurer and the owner of The Polyclinic and The Everett Clinic, who confirmed last month that thousands of patients might have to find new medical providers if the two sides can't reach an agreement.

The contract between Optum, the parent company of the two physicians' groups, and Regence BlueShield, a Seattle-based health insurance company, was initially set to expire Monday. Now, the companies have until Friday to reach a deal before nearly 19,000 Seattle area patients will have to either find new doctors or start paying higher, out-of-network rates.

The Polyclinic and The Everett Clinic said in a Monday statement that they've reached "an agreement in principle" with Regence BlueShield but didn't elaborate nor respond to related follow-up questions.

Regence leaders, meanwhile, continue to express frustration with the state of negotiations.

"We are extremely disappointed Optum has taken this position, affecting thousands of patients in Puget Sound, particularly during a tripledemic of COVID-19, flu and RSV," a Regence statement said Monday. "However, we cannot in good conscience agree to a contract that does not keep our members' best interests at the forefront."

The insurer declined to comment on whether any type of informal agreement had been reached.

A spokesperson for The Polyclinic said in a statement that extending the current contract for a few days will give patients "continued access to their trusted Polyclinic and The Everett Clinic doctors and care teams while the new contract is being finalized."

Neither company has shared specific details about negotiations, but Regence has said Optum is asking for "unsustainable rate increases" that would increase costs for members.

Most Polyclinic and Everett Clinic patients will be able to continue seeing their providers at in-network rates this week, but Optum's Medicare contract expired earlier this month and has yet to be extended, the statement said.

Patients with Medigap plans are not affected by ongoing negotiations and can still receive services from any provider that accepts Medicare. Medigap plans, or Medicare Supplement Health Insurance, are sold by private insurance companies to fill gaps in Medicare's original plan coverage.

Optum also plans to let its contract with Aetna's Medicare Advantage plans expire Jan. 1, according to a statement from The Polyclinic and The Everett Clinic earlier this month.

The Polyclinic will continue to contract with three Medicare Advantage plans in 2023, including Humana's HMO, PPO and D-SNP plans and Premera Blue Cross's HMO plan. The group will also continue to cover all plans with UnitedHealthcare, the health insurance arm of health care giant — and Optum owner — United Health Group, based in Minneapolis.

Meanwhile, feelings of frustration have continued to grow among Polyclinic patients who haven't had any luck getting answers or updates from Optum or Regence.

"Communications have been such a joke," said Carol Troup, who lives in Mountlake with her family of four, all of whom benefit from Polyclinic care. She follows the clinic on Facebook and has called their offices, but hasn't been able to get through to anyone with accurate information.

"I'm not at all surprised their messaging is so corporate and ridiculous and lacking entry info," Troup said. "But I think the fact that this is going to affect so many people is really huge."

Because she and her family have been Polyclinic patients for years, Troup wants to first see how contract negotiations play out before starting the search for new providers. In particular, her daughter is trans and sees a specific Polyclinic endocrinologist who's "wonderful" and helped her get onto a hormone treatment plan, Troup said.

"I'm just waiting," she said. "But I kind of feel like a fool."

For those looking for a new doctor, UW Medicine, Virginia Mason Franciscan Health, Providence Swedish and Overlake Medical Center in King County are in the Regence network. MultiCare, Providence Medical Group and Western WA Medical Group in Snohomish and Pierce counties are also in-network.

Regence also encourages patients who need help finding new doctors to call the number on the back of their member ID card.

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