Seattle Children's hospital files suit with the Office of Insurance Commisioner

October 4th, 2013 – This past week Washington residents began buying health insurance through Washington Healthplanfinder, the state’s new online health insurance marketplace.  There are seven insurers in King County offering health plans through the exchange.  Of those seven, only Group Health Cooperative and Community Health plan of Washington currently include Seattle Children’s Hospital in their provider network.  As a result, Seattle Children’s Hospital, has filed suit with the Office of Insurance Commissioner citing the “failure to ensure adequate network coverage.”

The issue here is two-fold.  A – When families enroll in one of the plans they may not realize that the pediatric hospital is not in their network of providers.  B) – Families that enroll in those plans that exclude Seattle Children’s Hospital could be subject to significantly higher cost-sharing amounts if they choose to seek care there.

As Dr. Sandy Melzer, the hospital’s Senior Vice President and Chief Strategy Officer explains, “The higher cost-sharing could seriously disrupt care for families currently receiving services at Children’s and could delay new patients from getting the specialized care.”[1]

Insurers are tasked with trying to find a delicate balance between an adequate network of providers and the market demand for affordable health insurance.  One of the re-surfacing concerns of the Affordable Care Act, affectionately known as Obamacare, is that the new plans sold through the exchanges will have a very narrow network of providers - this lawsuit underscores that notion.

“Children’s hospitals tend to have more expensive cost structures because of the complex needs of their patients,” said Jim Kaufman, Vice President of Public Policy for the Children’s Hospital Association. [2]

While there are new affordable options for Washingtonians seeking insurance through Healthplanfinder, there are issues developing regarding the narrow network of providers included in those plans as well as limited options for those who don’t qualify for government subsidies.

However, there are other resources available to ensure that individuals can obtain plans that include the providers they seek.  Individuals who visit will have access to four additional plans (not available on that are more comprehensive and in fact do cover Children’s Hospital, including Regence BlueShield, Moda Health, Assurant Health and Group Health Options.

[1] Landa, Amy Snow. “Seattle Hospital sues State over Exclusion from Exchange Plan Networks.” Seattle Times [Seattle] October 7, 2013.

[2] Carlson, Joe. “Seattle Children’s sues after exchange plans fail to include it in network.” October 8, 2013.