Seattle Children's Hospital excluded from most exchange plans

Majority of Washington’s Health Benefit Exchange Insurance Plans Fail to Cover Care at Seattle Children’s; Hospital Sues Seeking Adequate Network Coverage for Children and Families

Seattle Children’s Hospital, October 4, 2013 Today, Seattle Children’s Hospital filed suit citing the failure of Washington state’s Office of the Insurance Commissioner (OIC) to ensure adequate network coverage in several Washington’s Health Benefit Exchange (Exchange) plans. We believe strongly that the OIC and the majority of plans on the Exchange have failed to meet their mandate, as they do not currently cover care provided at Children’s. Children’s is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest. Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation. Without inclusion of Children’s, current and future patients and families who obtain insurance from several plans offered will not be able to access care at Children’s as an in-network provider. This lack of suitable access to pediatric services means that families enrolled in these plans may not receive the most timely, appropriate care, and face larger out-of-pocket amounts. “Every child should have access to essential healthcare and the intent of the new Exchange is to make it available to all families,” said Thomas Hansen, MD, CEO, Seattle Children’s. “However, we are very concerned about the limited networks being offered by some Exchange insurance plans. Omitting coverage for care at a facility like Children’s prevents families from accessing vital services they may desperately need.” http://www.seattlechildrens.org/Press-Releases/2013/Majority-of-Washington’s-Health-Benefit-Exchange-Insurance-Plans-Fail-to-Cover-Care-at-Seattle-Children’s;-Hospital-Sues-Seeking-Adequate-Network-Coverage-for-Children-and-Families/

Comment:

By Don McCanne, M.D. This press release from Seattle Children’s Hospital presents only one side of the story. Children enrolled in most of the plans to be offered in Washington’s insurance exchange will not have in-network access to the crucial, highly specialized services only offered by Seattle Children’s Hospital. The financial exposure to those families could be enormous. So what is the other side to this story? There is tremendous pressure on the exchange plans to keep premiums competitive. Although rates generally had been ratcheted down as low as the market will tolerate, they could squeeze a little more out from some providers by negotiating slightly lower rates in exchange for excluding health care competitors. These limited networks are an insurer-driven, cost-containment element of the new ACA exchanges. Imagine a Seattle child with a major malignancy or with the need for an organ transplant. Is it really reasonable that our “reformed” health care system still exposes that family to severe financial hardship and possibly bankruptcy? This is not what we should have expected from comprehensive health care reform. We need to go back and do it right – enact a single payer national health program that removes financial barriers to all essential care for everyone. Any child in Seattle that requires the specialized services offered by Seattle Children’s Hospital should have them. No exceptions.

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