Seattle hospital sues over state's new health insurance exchange

SEATTLE (Legal Newsline) -- Seattle Children's Hospital has filed a lawsuit claiming the state Office of the Insurance Commissioner failed to ensure adequate network coverage in several health plans being sold through the state's new online insurance exchange.

Children's is not included among the in-network providers on most plans available through the state's exchange, called Washington Healthplanfinder.

The hospital filed its lawsuit Oct. 4.

"We believe strongly that the OIC and the majority of plans on the exchange have failed to meet their mandate, as they do not currently cover care provided at Children's," the hospital said in a statement.

"Children's is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest. Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation.

"Without inclusion of Children's, current and future patients and families who obtain insurance from several plans offered will not be able to access care at Children's as an in-network provider."

That means families enrolled in those plans may not receive the most timely, appropriate care and face larger out-of-pocket amounts, the hospital contends.

"Every child should have access to essential health care and the intent of the new exchange is to make it available to all families," Dr. Thomas Hansen, CEO of Seattle Children's, said last week. "However, we are very concerned about the limited networks being offered by some exchange insurance plans.

"Omitting coverage for care at a facility like Children's prevents families from accessing vital services they may desperately need."

The hospital said it hopes a solution to the "concerning situation" can be found soon.

An OIC spokeswoman told The Seattle Times it is reviewing the hospital's petition.

Washington's exchange, along with other states', opened for enrollment Oct. 1 under the federal health care law.

From Legal Newsline: Reach Jessica Karmasek by email at jessica@legalnewsline.com.