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Agency outlines multiple provider–payer network disputes affecting SEBB members
Summary
Health Care Authority staff told the School Employees Benefits Board that recent provider–payer contract terminations and ongoing negotiations have left some members without in-network access in parts of Grays Harbor, Thurston and Yakima counties and that protections such as 60-day primary-care and 90-day continuity-of-care rules remain in effect.
Health Care Authority staff gave the School Employees Benefits Board (SEBB) an overview of four active provider–payer network disputes that could affect member access.
Dave Eiswinger, an agency staffer, said the Regence–Legacy Health dispute in the Oregon market had been resolved with a retroactive agreement to April 1, so claims after that date will be treated as in-network. "They actually did have a termination in April, on April 1… But the good news is they reached a new agreement, last week and that it was retro to April 1," Eiswinger said. He described that situation as a "closed chapter," while cautioning that members who experienced disruption still faced confusion and frustration.
Eiswinger also described a separate Oregon dispute with Oregon Health & Science University (OHSU) that is technically out of network on paper but is being treated as in-network for 365 days under a continuity arrangement while negotiations continue. He reported that a Regence–MultiCare termination took effect at 12:01 a.m. on May 10 and currently affects certain providers in Grays Harbor, Thurston and Yakima counties but not all MultiCare facilities. "This does not impact the entire MultiCare network… It impacts certain providers in Grays Harbor, Thurston, and Yakima Counties," he said.
Staff emphasized member protections and communications. Eiswinger reviewed state requirements that provide 60 days of in-network primary-care access after a contract terminates and 90 days of continuity-of-care protections for ongoing treatment, pregnancy-related care and terminal diagnoses. He urged members to engage with regional staff for continuity-of-care determinations and said the agency and carriers were fielding high call volumes about the disputes.
Chair Ryan Moran framed the problem in the context of larger market pressures on payers and providers and said the agency was reviewing policy levers to reduce member disruption. "We're… thinking through what might be some opportunities for future discussions of policy levers to provide to sort of mitigate this disruption for members," Moran said.
The board did not take any formal action related to the disputes at the meeting. Staff said they will update the board and members as negotiations develop and noted that a special open-enrollment event could be considered if negotiations leave members without realistic plan options.
