Official Release from Coordinated Care re: OIC Action for Exchange

As previously stated, Coordinated Care was disappointed with the OIC’s ruling on July 31, and filed an appeal shortly thereafter.  Our desire all along has been to work collaboratively with the OIC to file a high quality and consumer friendly Exchange plan.  We were informed by OIC counsel that they were not permitted to talk to us about corrections needed in our filings while an appeal was underway.  During our hearing with the OIC’s Administrative Law Judge this week, we learned that despite this stance regarding no communication, the OIC had started selective negotiations with other carriers who had been disapproved.

Our open, public hearing  this  week was a rigorous point by point discussion over every objection, including the network concerns addressed in the OIC’s statement today.  During the hearing, it became apparent that the OIC changed its position.  At the hearing, the OIC said that a pediatric specialty hospital was not a required element of a network, nor was a level 1 burn care center.  The only requirement was that these services be provided and covered for members, provisions that have been included in Coordinated Care’s exchange filing all along.   The OIC further acknowledged that there is a  current approved commercial plan in Washington that does not specifically include a pediatric specialty hospital in its network.

The Coordinated Care Exchange network contains contracts to provide the vast majority of needed pediatric care.  To provide certain pediatric specialty  and specialized burn services, the Coordinated Care plan provides payments to providers through single case agreements. The OIC acknowledged that single case agreements were a permissible way to provide specialty services not available in network, and that indeed this was currently being done in the Washington commercial health insurance market.  In other words, Coordinated Care’s network mirrored an already approved current and active commercial health plan in Washington.   Moreover, despite testimony at the hearing this week, if the OIC insists on inclusion of ‘a children’s hospital’  and level 1 burn care providers, Coordinated Care now has agreements with these providers and could include them in the network right away.

The OIC’s only remaining concern with the Coordinated Care network was the lack of the clarifying provision “Enrollees will not be subject to balance billing.”  Coordinated Care has added that single sentence to its revised plan.

For all but a couple of the other reasons articulated, the OIC acknowledged that those provisions of the plans could be reworked.  For the few that the OIC said could not simply be reworded, while legally not necessary to be changed, the OIC at the hearing – for the first time – articulated precisely what they view as the problem.  With that information, Coordinated Care could make the changes right away.

As stated, our preference would have been to discuss these issues with the OIC directly in the spirit of collaboration and solutions over the past few weeks. We are disappointed the OIC chose not to engage in settlement talks with Coordinated Care, while electing to do so with other plans.  We continue to request meetings daily to quickly resolve this with the OIC, and hope that now that the OIC has settled with two other plans, they will work with us to resolve any other issues. Additionally, we await the Administrative Law Judge’s decision.