Dispute may see The Everett Clinic exit Regence's provider network
Thousands of residents who have health plans with Regence BlueShield and go to The Everett Clinic, including Boeing employees and K-12 staff whose enrollment windows closed last week, may need to find a new doctor if the two entities cannot agree to terms of renewal for the contract that keeps the chain of walk-in clinics in the insurance provider's network.
The two entities were still negotiating as of last week, both The Everett Clinic and a spokesperson for Regence affirmed.
The end to this year's Medicare open enrollment looms Dec. 7. Boeing's enrollment ended last week, and most chose the standard plan through Regence BlueShield.
In letters sent to members, Regence said it may not keep The Everett Clinic in its network because the clinic's owners, Optum, are asking for a double-digit rate increase for services.
Regence gave a statement to the Tribune that The Everett Clinic would be considered an out-of-network provider starting Dec. 5 for Regence Medicare Advantage members, and starting Dec. 19 for Regence members with employer-sponsored health coverage.
In a letter Optum sent to affected Regence members which the Tribune obtained, it said the contract terms Regence “offered do not adequately support the care of our patients.” Its letter adds that “it is important that we have contracts with health plans that allow us to do what is right for each patient, provide excellent care and continue to serve our community to our best ability for the future.”
Regence's statement says "We are disappointed that the for-profit, out-of-state owner of The Polyclinic and The Everett Clinic is planning to remove these local clinics from our provider network after demanding double-digit increases in what we pay them for care."
It adds: "Our premiums are based on what we expect care to cost. When providers demand unsustainable rate increases to provide care, our members and customers pay more out of pocket.”
Regence's last renewal with The Everett Clinic was from last-minute negotiations in 2016.
Optum acquired The Everett Clinic in 2018 from the chain's owner DaVita Medical Group. It also bought The Polyclinic hospital group in King County in 2019. Optum is a subsidiary of UnitedHealth Group, a publicly traded corporation that also owns the health insurer UnitedHealthcare.
Regence's letters were sent right before the insurance enrollment period for K-12 school employees closed Nov. 22. The insurance enrollment period for public government employees has long been scheduled to close this week.
Premera Blue Cross is not affected. Premera is separate from Regence BlueShield.
Update Nov. 29: This story's headline has been modified.
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