Uniform insurance changes for WA (State employees, insured & providers plz read)

[uppityperson]

I am a Preferred Provider for both these insurance companies and have recently heard of some drastic changes they are making that have the potential to impact both insured and providers of Uniform insurance. By the way, this will impact State Employees as they have Uniform insurance. You will most likely have a more difficult time finding someone to take your insurance, and they will most likely be much busier resulting in longer wait times.

Effective August 2, 2010, Uniform Medical Plan (UMP) will no longer credential new providers. UMP will terminate
all professional provider contracts effective December 31, 2010. The terminations result from UMP’s new contract with
Regence BlueShield for third-party administrative services beginning January 1, 2011. The services provided by
Regence will include their professional provider network.

For 2011, you must be in the Regence BlueShield network to be considered a network provider for UMP enrollees.

Simply put, if you have UMP insurance, you will be more limited as to whom you can see for what. Some categories of providers have quite a few people in them, some have minimal. If you are a provider and NOT a PP for Regence (who is known for their strict limitations), you won't be able to get paid by the insurance co.

And Regence is expected to lower reimbursment rates for providers.

In Washington, health insurers and their network contractors must file their provider agreements with the Insurance Commissioner for approval prior to use. (See WAC 284-43) However, the mere fact that these contracts are “filed” does not automatically mean that the contract is either good or acceptable to practitioners. The approval merely means that the contract satisfies regulatory requirements. The law neither requires Regence to contract with
all practitioners nor sets standards for the level of reimbursement. Despite the insurer’s size relative to the practitioner, it’s a “free market.”

State Insurance regulations aim to achieve just two goals. The first standard requires every network to contract with a sufficient number and type of health care practitioners to assure that consumers have access to promised health plan benefits through an adequate choice of practitioners . The second standard prohibits networks from manipulating practitioner selection to discourage or avoid unhealthy consumers from purchasing the plan . To underscore the limited nature of the regulatory standard, the rules explicitly provide that:
The provisions of do not require a health carrier to employ, to contract with, or retain more providers
or facilities than are necessary to comply with the network adequacy standards of this chapter. WAC 284-43310(3)
Regence may use restricted networks, may select individual practitioners within any licensed health care, and they may
force consumers who have purchased certain plans to use only a subset of network practitioners. In an era of health care
reform, insurance companies are rewarded for their ability to manage the cost and quality of care through their creation and management of networks.

For those who believe the Insurance Commissioner can adopt a rule to change this and require Regence to contract with
practitioners, know that the Legislature has often considered and rejected legislation that would permit the Commissioner to write such rules. Instead, the Insurance Commissioner requires companies to submit reports detailing the number, type and distribution of health care practitioners within a network. The Commissioner will take action only when such reports indicate that the network is inadequate. In any case where the health carrier has an absence of or an
insufficient number or type of participating providers or facilities to provide a particular covered health care service, the carrier shall ensure through referral by the primary care provider or otherwise that the covered person obtains the covered service from a provider or facility within reasonable proximity of the covered person at no greater cost to the covered person than if the service were obtained from network providers and facilities, or shall make other arrangements acceptable to the commissioner. The health carrier shall establish and maintain adequate arrangements to ensure reasonable proximity of network providers and facilities to the business or personal residence of covered persons. Health carriers shall make reasonable efforts to include providers and facilities in networks in a manner that limits the amount of travel required to obtain covered benefits. For example, a carrier should not require travel of thirty miles or more when a provider who meets carrier standards is available for inclusion in the network and practices within five miles of enrollees.

Applying this standard to Olympia, Regence must demonstrate that a sufficient number of licensed massage practitioners have been included in its network to assure timely access to massage services by state employees within 30 miles of Olympia. If Regence can demonstrate that it has achieved this goal, then Regence will have satisfied network legal requirements in contracting with practitioners. For those who struggle to provide quality health care services to
their patients and face the prospect of losing patients who cannot afford to obtain the same care without Regence benefits, I can only offer the meager advice that practitioners should always strive to avoid dependence upon a single insurer and take time to consider ways to diversify in this lousy economy.
—John Conniff attorney

Here are phone numbers to contact people, I am starting with the Insurance Commissioner and WHCA as the insurance co's don't give a damn beyond profit and the IC and WHCA work for the people.

Uniform Medical Plan Provider Services:
Toll-free 1-800-464-0967
Local [phone]
Fax [phone]

Regence Blue Shield
Phone: [phone]
Fax: [phone]
Fax: [phone]

The Office if the Insurance Commissioner
http://www.insurance.wa.gov/
1-800-562-6900

Washington State Health Care Authority
http://www.hca.wa.gov/contact.html

Taken from this AMTA notice
http://www.amta-wa.org/clientuploads/p12_13_Fall_WMJ.pdf