Suit Alleges Children's Hospital Left Out of Health Exchange Plans

Oct 4, 2013

Seattle Children’s Hospital has filed a suit against the state Office of the Insurance Commissioner, alleging it was largely cut out of the state’s new health insurance exchange.

There are eight insurance companies on Washington HealthPlanFinder, the marketplace that opened this week for individuals shopping for coverage. Six of them don’t include Seattle Children’s Hospital in their networks.

Children’s is King County’s only pediatric hospital, and the only one in the region to offer specialties like acute cancer care. Pediatrician Sandy Melzer says a plan that doesn’t include those services simply isn’t providing full coverage.

“If you then offer people this product and you say, ‘OK, now you have insurance, but you don’t really have insurance because you can’t get this care that we’ve promised you,’ then you’ve really defeated, in some ways, the primary point of the exchange, [which] was to make sure that people could get care for themselves and their children,” Melzer said.

Children’s Hospital is suing to have two of the insurance companies, namely Coordinated Care and Molina, kicked off the exchange. The lawsuit blames the state insurance commissioner, who initially rejected those companies but was overturned by a judge.

The commissioner’s office says it can’t say much about a pending lawsuit, but did issue a statement saying it takes concerns about access to care very seriously.

Insurance providers say they’ll negotiate case-by-case when patients need access to the hospital. Melzer says such an approach can delay care for sick children, and leaves families vulnerable to higher bills.