Jo Ford, 74, and her husband Bernard Ford, 80, sit together beneath a gazebo at the Stilly Valley Center on Saturday, Jan. 7, 2023, in Arlington, Washington. The couple has been married for 52 years and have both received medical care from The Everett Clinic for most of their lives. They are now looking for other care providers because of confusing and incorrect information from the clinic during its ongoing contract dispute with Regence over Medicare Advantage plans. (Ryan Berry / The Herald)

Jo Ford, 74, and her husband Bernard Ford, 80, sit together beneath a gazebo at the Stilly Valley Center on Saturday, Jan. 7, 2023, in Arlington, Washington. The couple has been married for 52 years and have both received medical care from The Everett Clinic for most of their lives. They are now looking for other care providers because of confusing and incorrect information from the clinic during its ongoing contract dispute with Regence over Medicare Advantage plans. (Ryan Berry / The Herald)

In Medicare Advantage stalemate, Everett Clinic patients left in limbo

The Everett Clinic has apparently turned away patients with Regence coverage, despite the provisions of a public health emergency.

EVERETT — A few days after Christmas, Mel drove his wife to The Everett Clinic in Shoreline, their usual place of care. She was having trouble breathing, likely a complication of a respiratory illness and asthma.

But the clinic refused to see her, saying it would not accept patients with Regence Medicare Advantage plans, Mel said. They gave her a paper with a list of clinics that would probably treat her. This was about one week after Mel received care for the same respiratory distress in California, with no problems.

Mel, who asked that his last name not be published, wrote in an email: “We are shaken to realize that we have no contact allowed with our usual and long-standing sources of primary and specialty care! In our mid- seventies, this is no small development!”

As The Daily Herald reported in December, when Regence and Optum — the parent of The Everett Clinic — settled commercial contracts in late December, the deal did not include Medicare Advantage plans. Some seniors buy these plans from private insurers, rather than coverage through traditional Medicare. Regence and Optum are still negotiating.

Regence did not respond to a request for the number of affected Medicare members left in limbo. But a spokeperson confirmed denials of care: “We are very concerned by numerous reports we’ve received from our Medicare Advantage members who have been refused care by The Everett Clinic and The Polyclinic.”

Medicare Advantage operates under different rules than commercial plans, with the federal government dictating the ground rules and paying a fixed amount per patient each month.

But Regence had promised Medicare Advantage members that during the federal COVID public health emergency, they could “receive out-of-network services covered at in-network cost sharing” at Optum locations.

A spokesperson for the Center for Medicare and Medicaid Services confirmed that according to current regulations, during disasters or emergencies, including federal public health emergencies, “Medicare Advantage plans must cover services provided by non-contracted providers so long as there is a disruption of access to health care.”

Jo Ford, a patient of The Everett Clinic for more than 50 years, said she felt “alone” when she heard Regence and Optum had settled for all contracts except Medicare Advantage.

“We are just swimming in the ocean, just grasping for the life ring,” Ford said. “We’re on our own. And how many other seniors are in the water with us? We have no idea. I’ve heard it’s thousands, speaking with Regence.”

Ford said she loves the care The Everett Clinic has given her and her husband. But they recently told her she’d have to pay out of pocket for a routine screening. She talked with Regence, who told her that’s incorrect.

“It’s back and forth, the information I get is confusing,” Ford said.

In response to a question about how staff have been instructed to treat Regence Medicare Advantage members, spokesperson Tenzin Choephel said Optum is trying to resolve the dispute with Regence and provide patients the best care possible.

“We are hopeful that we can come to a mutually beneficial resolution with the Medicare Advantage contract. During this time, we have worked with Regence to ensure existing appointments, procedures and surgeries occur and continuity of care coverage is provided to qualified Medicare Advantage patients,” Choephel said.

After The Everett Clinic sent them away, neither Mel nor his wife contacted Regence. Instead, Mel reported he had burned through the battery on his cell phone on Friday, trying to find a nearby primary care provider who would accept new patients anytime soon. He had failed so far and did not feel optimistic.

Ford only just decided on Wednesday to find another primary care provider. They will require her to do an initial visit, and then schedule the screening — delaying her care for months, she said.

In the meantime, she has an important test scheduled with The Everett Clinic in March, and she’s worried about how that will work out. If the public health emergency is still in effect, which it most likely will be, she should be fine, according to Regence’s letters and statement.

The U.S. Department of Health and Human Services has promised to provide 60 days’ notice before ending the COVID public health emergency. If it follows that promise, the expiration will be pushed back 90 days after Jan. 11.

Medicare Advantage members can change their plan right now, during open enrollment. One of their options, UnitedHealthcare, is owned by the same parent company, Optum.

We will continue to report on access to health care in 2023. If you have faced barriers to accessing timely, convenient or affordable care in Snohomish County, please fill out this brief form: forms.gle/DcgfccCvwqVTh6Sk7

Joy Borkholder is the health and wellness reporter for The Daily Herald. Her work is supported by the Health Reporting Initiative, which is sponsored in part by Premera Blue Cross. The Daily Herald maintains editorial control over content produced through this initiative.

Joy Borkholder: 425-339-3430; joy.borkholder@heraldnet.com; Twitter: @jlbinvestigates.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Vernon Streeter looks over the fence at the Skykomish Substation operated by Puget Sound Energy on Monday, Nov. 4, 2024 in Skykomish, Washington. (Olivia Vanni / The Herald)
‘Doesn’t make any sense’: Skykomish residents decry increased outages

Community members are frustrated about power outages and a lack of communication from Puget Sound Energy.

Glacier Peak, elevation 10,541 feet, in the Glacier Peak Wilderness of Mount Baker–Snoqualmie National Forest in Snohomish County, Washington. (Caleb Hutton / The Herald) 2019
2 years later, Glacier Peak seismometers delayed again

The U.S. Forest Service planned to install them in 2023. Now, officials are eyeing 2026.

Washington Attorney General Bob Ferguson speaks at the Snohomish & Island County Labor Council champions dinner on Tuesday, Oct. 10, 2023 in Everett, Washington. (Olivia Vanni / The Herald)
Ferguson, WA Democrats prepare for new era of showdowns with Trump

Gov.-elect Bob Ferguson and Attorney General-elect Nick Brown are readying their legal teams.

Benson Boone (Photo provided by AEG Presents)
Monroe’s Benson Boone snags Grammy nomination for Best New Artist

The Monroe High grad this year has opened for Taylor Swift and won an MTV Video Music Award.

Lynnwood
Lynnwood caregiver accused of $674K check fraud

Prosecutors allege Sheila Saluquen defrauded the elderly owner of a car dealership for over a year.

Deborah Rumbaugh
‘Very hostile work environment’: Stanwood-Camano school supe resigns

Superintendent Deborah Rumbaugh said Tuesday she’ll be gone at the end of the school year.

Snohomish County Superior Courthouse in Everett, Washington on February 8, 2022.  (Kevin Clark / The Herald)
WA court system outage means firearm sales on hold

Buyers must wait until the Washington State Patrol can access databases for background checks.

David Hope, a Everett AquaSox ticket holder since 1994, talks about the stadium proposal presented to the public during a community information session on Tuesday, Nov. 12, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
Everett residents voice support, concerns over AquaSox stadium

On Tuesday, the city presented potential plans for a new or renovated stadium and fielded questions.

A state Department of Transportation traffic camera from Highway 527 shows the aftermath of a school bus crash Wednesday afternoon on I-405. (Photo provided by the state Department of Transportation)
I-405 reopens after school bus crash blocked lanes in Bothell

The bus was carrying a girls soccer team from La Conner. No one on the bus was reported injured.

Flyers of support for Democratic gubernatorial candidate Bob Ferguson. (Laurel Demkovich / Washington State Standard)
Somers, Liias among Snohomish County leaders on Ferguson transition team

Gov.-elect Bob Ferguson on Tuesday announced a 53-person team that will help with the transition from Gov. Jay Inslee.

The line for the Snohomish County Auditor’s Office extends around the Admin West building and onto Pacific Avenue Election Day as people wait for same-day registration, ballot issuance, and accessible voting services on Tuesday, Nov. 5, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
Snohomish County voter turnout down from 2020

Meanwhile, local Republicans celebrated the national results. And Democrats applauded the local.

People board a bus at the Canyon Park Park & Ride Swift Green Line stop in Bothell, Washington on Wednesday, Oct. 18, 2023. (Annie Barker / The Herald)
Big changes ahead as Community Transit mulls $254M budget

As ridership increases, Community Transit is planning for more service, security and a lower-emission fleet.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.