19K Seattle-area patients could face steep bills or be forced to find a new doctor

A dispute between the owner of the Polyclinic and a major insurance company could affect nearly 19,000 patients in Western Washington. It could leave them with a choice between higher medical bills or finding a new provider.

The people caught in the middle are Regence BlueShield insurance customers who get their health care at the Polyclinic, a multi-specialty health clinic that has nearly a dozen locations in the Seattle area. Also, the Everett Clinic, which has nearly two dozen locations, most of them in Snohomish County. In 2019, all those clinics were bought by Optum, a subsidiary of the large health-care company UnitedHealth Group.

The dispute is about how much those clinics should be paid for the care they provide. This is the first time negotiations between these clinics and Regence have gotten this close to the wire.

The insurer, and the owner of the clinics, have until Dec. 19 to come to a deal. But many Regence customers have only until the end of Wednesday to switch insurance companies before the end of open enrollment, if their employer offers another option. Open enrollment at some employers, like Boeing, is already over.

If the Polyclinic and Everett Clinic no longer have a contract with Regence, patients could opt to pay higher, out-of-network costs, or they could go to UW Medicine, Swedish, Virginia Mason, or some other providers for their care.

With 19,000 other patients possibly in the same boat, that could be a lot of competition for doctor’s appointments.

If the split goes through, and Regence customers become unable to access their benefits because of a lack of in-network providers, the Office of the Insurance Commissioner could levy a fine or take a different enforcement action against the insurance company.