Board asks city attorney to review insurer's demand to match lowest third‑party reimbursement rates

The Culture & Leisure Services Board voted to ask staff to consult the City Attorney after staff summarized a request from a third‑party payer — identified in staff materials as Optum Health Care Solutions (also operating under Renew and AAY) — that the city attest its rate for program participants is no higher than rates paid by other providers.

According to staff, Optum’s communication said the city must either attest that Optum’s reimbursement rate is equal to or lower than rates paid to other third‑party payer programs or amend its contract so Optum receives the lowest provider rate. Staff warned the board that complying could reduce the city’s per‑member payments or exclude Optum members from using city benefit programs.

The director summarized the options and context, and noted that other contracts in staff files include confidentiality language and watermarks that limit sharing proprietary rate information. Staff said Renew (Optum) currently covers 187 members who use the city benefit; roughly 90% of those are seniors and about 60% are city residents. By contrast, Ash Fitness covers about 135 members and Silver Sneakers pays the city approximately $27 per month after recent negotiations.

Board members described the email language as inappropriate and potentially unlawful; one member compared the request to a form of market control. A motion that staff consult the City Attorney about the attestation requirement was seconded and approved by the board. Staff will provide the attorney’s guidance and bring the matter back to the board.