Get the inside scoop on how provider network negotiations work.
PEBB and SEBB health plans have insurance carriers that administer the medical plans, such as Regence BlueShield, Premera Blue Cross, Kaiser Permanente, or UnitedHealthcare. Part of administering the plans includes managing the provider networks, including hospitals, physicians, and pharmacies that are contracted with the plan to provide services. All plan carriers in Washington State are required to maintain their provider networks so there are enough providers to ensure members have reasonable access to covered services without undue delay.
How will I know if my provider may leave my plan’s network?
The plan carriers and the providers, like other businesses, have contracts with expiration dates. That means they routinely have to negotiate new contract terms. Sometimes these negotiations take more time and can come very close to the contract expiration date. The contract negotiations are between the plan carrier and the provider and do not include HCA.
The Office of the Insurance Commissioner (OIC) requires the plan carriers to notify affected members 30 days before the contract ends. The notice tells members that the provider may be leaving the network and provides resources for finding a new in-network provider. If an agreement is reached, the carriers send a follow-up notice to the affected members.
What if I have concerns about the network change?
If you have been notified of a potential network change and have concerns, you should contact your plan to voice your concerns and seek assistance if needed. Contact information should be provided in the notice you get from the plan carrier. You can also find plan contact information on the HCA website. Select your member type (public employees, school employees, retirees, PEBB Continuation Coverage, or SEBB Continuation Coverage), and then select Contact the plans under Get help.
Although HCA monitors network negotiations and will sometimes provide additional information when the network change could affect members, we cannot influence the outcome of potential network changes.