ER doctors, insurance companies settle dispute

Published 10:51 pm Monday, July 9, 2007

A long-running dispute between emergency room physicians in Everett and Monroe and an insurance company that left thousands of consumers paying more out of pocket has come to an end.

Premera Blue Cross and North Sound Emergency Medicine have agreed to a new 31-month contract that lasts through 2009.

Details of the contract were not disclosed.

“It’s been a long road,” said Bill Akers, vice president of health care delivery for Premera Blue Cross. “I’m glad it’s over, and I’m sure our members are, too.”

The agreement ends a contract dispute starting in October 2004 between the emergency room physicians and two of the state’s biggest insurance companies, Premera and Regence BlueShield.

Because the doctors and the insurers were unable to reach an agreement on payment rates, patients who had health insurance through these two organizations ended up paying more out-of-pocket costs, sometimes several hundred dollars.

Regence settled with the physicians in January. This was about a month after Valley General Hospital in Monroe paid for ads in local newspapers with a statement from its chief executive, Mark Judy.

In the ads, Judy said patients were becoming pawns in the dispute.

“When people come to the emergency room and expect a $75 co-pay and end up with a bill of $300 to $400, it’s a huge issue,” his statement said.

Liam Yore, president of North Sound Emergency Medicine, said that the ads affected negotiations.

“I think that provided a little kick start” to help break the impasse with the health insurance organizations, Yore said.

North Sound Emergency Medicine employs 40 physicians who work under contract at the emergency rooms at the hospitals in Everett and Monroe.

The agreement means “we will make many of our emergency room patients happy,” said Gail Larson, chief executive of Providence Everett Medical Center.

“‘This has been a challenge for them to go to the emergency room, find that the hospital has a contract with Premera but the emergency room physicians do not, which meant more expense for the patient. We certainly knew that the public was not happy,” she said.

About 5.25 percent of the 100,000 annual patient visits to the Everett hospital’s emergency department are ensured through Premera, said Chet Taylor, director of finance.

Premera patients make up about 8 percent of the 20,400 annual patient visits to Valley General Hospital’s emergency room in Monroe, said spokeswoman Kathy Nelson.

The hospital received three to four complaints a week about the issue, she said.

“It’s helpful for our patients who use our emergency room,” said John Beltz, the hospital’s chief financial officer said of the contract agreement. “They’ll no longer be required to pay the additional fees.”

Akers, the Premera vice president, declined to comment on whether the contract agreement would result in a rate increase for consumers.

“Certainly the cost of health care is rising all the time,” he said. “There are lots of costs that drive up health care costs, not just the emergency room.”

Reporter Sharon Salyer: 425-339-3486 or salyer@heraldnet.com.