Premera Contract Negotiations with UW Medicine: Guidelines for Medical Staff

4/18/2023

UW Medicine is in negotiations with Premera Blue Cross on new commercial and Medicare Advantage contracts beginning July 1, 2023.

Unless renewal terms are agreed upon, UW Medicine will no longer be contracted for Premera Commercial and Medicare Advantage plans, effective July 1, 2023. As a result, Premera patients may be required to pay for a larger share, up to the full cost, of services provided.

Affected contracts with Premera include:

Harborview Medical Center
UW Medical Center – Northwest
UW Medical Center -- Montlake
UW Medicine Primary Care
UW Physicians, including services provided at Fred Hutchinson Cancer Center
Valley Medical Center

UW Medicine is committed to engaging in productive discussions with Premera to negotiate reimbursement rates that fairly address the costs of care. If negotiations fail or stall, we will begin notifying patients in late May that their care may no longer be contracted beginning July 1. If this occurs, we will need to have patients sign forms to accept financial responsibility for services that are not covered by their insurance plan.

We are directing patients to contact Premera directly at the phone number on the back of their insurance card if they have questions or concerns about this potential change or for information regarding authorization for services that are scheduled on or after July 1, 2023.

To help answer other questions, we have prepared talking points and key resources, see below. For general information, you can also direct patients to our Frequently Asked Questions.

We value our relationship with Premera patients and hope to continue being their partner for healthcare.

The following conditions may apply to services received at Valley beginning July 1, 2023, if contracts are not renewed:

Commercial/PPO

Most commercially insured Premera (PPO) members will have access to an out-of-network benefit, which would provide for reimbursement of some of the bill; however, the member would likely be responsible for the remaining balance.
Premera commercial PPO members should be directed to Premera and/or their employer’s Human Resources or Benefits department for a full explanation of their benefits coverage and financial obligations, as well as any continuity of care allowances for coverage.
Premera commercial PPO members should be directed to Premera for alternative contracted or in-network provider options.
Premera commercial PPO patients wishing to continue their care after being informed of the possibility of a higher out-of-pocket cost share should be presented with all relevant financial responsibility forms prior to delivery of services.
Premera commercial PPO patients with appointments scheduled for July 1, 2023, or later may be rescheduled to a service date prior to July 1.

Medicare Advantage (MA)

Most Premera Medicare Advantage (MA) members may continue to see Valley providers; however, it is likely that a MA member will be responsible for a higher out-of-pocket payment amount for services.
Premera MA members should be directed to Premera for a full explanation of their benefits coverage and financial obligations, as well as any continuity of care allowances for coverage.
Premera MA members should be directed to Premera for alternate contracted or in-network provider options.
Premera MA patients with appointments scheduled for 7/1/23 or later may be rescheduled to a service date prior to 7/1/23.

SCRIPTS

Call to a patient scheduled for services after June 30, 2023

Hello, I am calling from Valley Medical Center to inform you that, effective July 1, 2023, healthcare services at UW Medicine hospitals, including Valley, may no longer be contracted with Premera Blue Cross for Commercial or Medicare Advantage plans.

We are currently in negotiations to extend our agreement. If Premera and UW Medicine cannot reach an agreement on renewed contracts and if you receive care at UW Medicine after June 30, 2023, Premera may not cover the full cost of your care. As a result, you may be responsible for paying a larger share, up to the full cost, of the services provided.

This includes care received at UW Medical Center, Harborview Medical Center, UW Medicine Primary Care and UW Physicians, including UW Physicians services at Fred Hutchinson Cancer Center, and Valley Medical Center.

We recommend that you contact your Premera insurance plan or your employer’s Human Resources department with any questions regarding coverage.

Patient call to Valley/clinic regarding Premera contracts

Effective July 1, 2023, healthcare services at UW Medicine hospitals, including Valley Medical Center, may no longer be contracted with Premera Blue Cross for Commercial or Medicare Advantage plans.

We recommend that you contact your Premera insurance plan or your employer’s Human Resources department with any questions regarding coverage.

Option to Reschedule Appointments

Background: Clinics may receive requests from Premera PPO and MA members to reschedule appointments so that they are covered under current contracts. Likewise, some clinics may wish to proactively contact patients to reschedule. Clinics should accommodate requests for rescheduling whenever possible. Any such efforts should be conducted based on the typical scheduling processes and policies of Valley.

TALKING POINTS

We can try to reschedule your services to occur prior to July 1, 2023, so the services will be covered by Premera under your current plan.
If contracts are not renewed, after June 30, 2023, you may be responsible for paying a larger share, up to the full cost, of the services provided.
We recommend you contact your Premera insurance plan or your employer’s Human Resources department with any questions regarding coverage.

Key Resources & Contact Information for Inquiries

Please refer to the FAQs and resources at uwmedicine.org/premera
Patients can contact Premera and/or their Employer HR/Benefits office for questions about continuity of care and out-of-network benefits
Current Valley patients can be directed to the PRC at 425.690.3535
Valley Financial Advocates are available to assist with alternate coverage options at 425.656.5599
Find a new provider at: valleymed.org/find-a-provider
For staff, if the answer to your question cannot be found after reviewing the posted resources, please contact terry_fitzgerald@valleymed.org.