One of Washington’s largest health insurance providers will drop most Providence, Swedish and CHI Franciscan providers from its network for individual health insurance plans starting in 2017.
The change will not affect the vast majority of Premera policyholders who are insured through employer-sponsored or Medicare plans.
Premera announced Thursday it would also stop selling individual plans under the Premera name and its subsidiary, Lifewise, in 12 Washington counties: Chelan, Douglas, Ferry, Kittitas, Lewis, Lincoln, Mason, Pend Oreille, San Juan, Skagit, Stevens and Yakima.
The change comes a week before the state Office of the Insurance Commissioner is expected to announce rate increase requests for 2017 health insurance premiums. Premera has requested a 19.6 percent rate hike, spokeswoman Melanie Coon said.
Providence spokeswoman Colleen Wadden noted no changes will occur until next year and people can change health plans during this fall’s open enrollment if they want to stay with their Providence physician or hospital.
“Our intent is to continue to participate in other Premera products for 2017, as we are negotiating the terms of our future relationship with Premera,” she said.
About 155,000 Washingtonians have individual Premera or Lifewise plans purchased through the state health insurance exchange or directly from the Premera website, Coon said. About 17,000 of those people are in the affected counties.
The network changes also affect a small number of employer-sponsored plans. Customers can see if they’re affected by looking at the network name on their health insurance cards. Plans in the Heritage Prime network, which is employer-sponsored, and the Heritage Signature Network, which is individual, will no longer have access to most providers in the Providence, Swedish and Franciscan systems.
A handful of hospitals and facilities from the dropped providers will remain in-network to provide adequate care in places with few options.
Facilities remaining in-network include St. Luke’s Rehabilitation Institute in Spokane, Providence St. Joseph’s Hospital in Chewelah, Providence Mt. Carmel Hospital in Colville and Providence St. Mary Medical Center in Walla Walla. Rockwood Health System will remain in-network.
Coon said the changes are in response to rising health care costs as more people have signed up for coverage through the Affordable Care Act. Premera saw a spike in claim costs in 2015, the second year many people had insurance through individual plans.
Coon said many of those customers had been deferring medical care for years and spent more on health care once they figured out how to use their new insurance plans. That drove up costs across the system, she said.
Costs have been especially high in many rural areas where there’s little competition, Coon said. Premera was faced with a choice between raising premiums further or exiting the market in some counties entirely.
“We can’t offer competitive rates if we’re everywhere in the state,” she said.
Without the changes, Coon estimated, Premera would have asked for a rate increase closer to 25 percent.
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