Contract negotiations leave Regence policyholders in limbo

Nearly 19,000 people in Washington have received a letter from their insurance company, Regence.

Those people were told that their coverage options might look different starting in December. It’s caused a lot of confusion and worry among policyholders, many of whom are on state-subsidized plans.

Nora Davis is a volunteer state health insurance benefit advisor, also known as a SHIBA.

"I work one day a week, helping people select their Medicare plans, troubleshoot their Medicare plans, essentially, all things related to Medicare," Davis says.

Recently, Davis has been hearing from people who have questions about what their insurance will cover in the new year.

"They're concerned, they want to continue seeing The Everett Clinic and Polyclinic," she says.

The Everett Clinic and the Polyclinic’s parent company, Optum, is in contract negotiations with Regence.

If they can’t come to an agreement soon, many of those 19,000 people will need to either change their health-care provider, or pay out-of-network fees to see their doctors, at least until a new contract can be agreed upon, assuming it will be at all.

There are a lot of people covered by Regence, including Boeing employees, and school, and public employees – and, to be transparent, a number of KUOW employees.

For some of the Medicare customers Davis is assisting, there are options. Some Medicare Advantage plans will still include the Polyclinic and the Everett Clinic. This change won't impact people who use a Medicare Supplement, or Medigap, plan.

"If somebody is on a Medicare Advantage plan that includes The Everett Clinic and or the polyclinic, they can enroll in a different Medicare Advantage plan before the end of open enrollment, which ends on December 7th," Davis says.

"And in Snohomish County, there are other options available if they're not able to enroll in a plan by December 7th. They have another opportunity during the Medicare Advantage open enrollment period, which is from January 1st to March 31st, to change their Medicare Advantage plans."

But for the thousands of people who don't have a Medicare Advantage plan, there are fewer options

For many, open enrollment has already ended for the year. For others, it ends today – Nov. 30.

Davis worries about all the people who will have to shift their care.

"There definitely are other doctors and facilities in Snohomish County that accept Medicare," she says. "But as with all types of doctors and insurance plans, are their panels open to accepting new patients at this time?"

It’s a fear Everett Herald health reporter Joy Borkholder has heard as well.

She reported on the split after hearing from local Everett Herald readers, many of whom go to the Everett Clinic.

"They have these long established relationships at The Everett Clinic, some of them decades. And they largely like their doctors," Borkholder says. "They don't want to lose that, as well as they're really afraid of trying to find new doctors in an area where a lot of people have to wait months for primary care or a specialist."

In a letter sent to one of its brokers, Regence said that Optum was asking for "an unprecedented double-digit increase in rates," Borkholder says. Regence did not respond to direct questions about what their expected provider rate increase would be.

Regence and Optum's current contract is set to expire soon. When exactly depends on the kind of insurance you have.

For Medicare Advantage members usually it would expire on Dec. 5. But a clause due to the federal Covid health emergency means that date has been moved to Jan. 11.

For non-Medicare Advantage members the contract will expire on Dec. 19.

There is no set date on when Regence and Optum have to broker a new contract. They're only required to give 30 days notice before the old contract ends. So, what happens next between the two companies is up in the air.

State benefit advisor Davis did offer some advice for anyone currently receiving ongoing care at the Everett Clinic.

"I would highly recommend that they contact their provider and find out if there's any continuity of coverage that's going to happen during this situation," she says.

According to Washington state’s Health Care Authority, some patients will be able to receive continuing in-network treatment for a limited time. That includes people who are pregnant, receiving inpatient care, or who are terminally ill.

You can find more information about the Polyclinic and The Everett Clinic's ongoing negotiations with Regence, as well as potential continuity of care, at this link.