Regence, EvergreenHealth in contract negotiations
EvergreenHealth, an independent healthcare provider, and Regence, a health insurance company, have notified their members that EvergreenHealth could stop accepting Regence insurance on November 1, 2025.
This type of announcement is not uncommon between healthcare providers and insurance companies. The two entities work together on a contract basis and those contracts occasionally need to be re-negotiated.
When that happens, and there’s a chance the negotiations don’t result in an agreement to continue the contract, insurance companies are required to inform their members that their health care provider (like their doctor, or preferred clinic, or specialist) may be out of network on the day the contract ends.
Written notifications must be sent to members 45 days before the contract could end. (That’s up from 30 days, which was the standard before Senate Bill 5579 was sworn into law in July.)
What members should know
You’ll still have adequate hospital access, and you can limit your out-of-pocket costs by seeing other providers in their plan.
Additionally, if you’re receiving treatment for a covered, serious and complex condition, you may be able to continue care with those providers, thanks to a federal law that assures continuity of care. (The law was included in the Consolidated Appropriations Act of 2021 — the No Surprises Act).
The 45-day notice letter should include details on what your next steps will be, but you won’t get a special enrollment because a provider or facility is leaving the network.
What’s the OIC’s role in all of this?
The OIC typically doesn’t get involved in negotiations like that, but when an agreement is reached, we can expedite review of those contract submissions for approval.
It’s worth noting that these are usually contract termination situations. The parties were under contract, and one party exercised their contract right to send notice of potential termination, which is permitted under the terms of the contract. It’s not a situation where a contract was being negotiated or finalized.
The OIC has adopted network access standards to ensure people have access to a sufficient number, type, and distribution of health care providers and facilities.
