As a part of the Attorney General of Washington State’s examination of health care billing, a consumer protection complaint was brought against Swedish Health Services and Providence Health & Services Washington.
The complaint was brought after a contract dispute between Premera Blue Cross and CellNetix resulted in CellNetix being temporarily out of network for certain Swedish and Providence patients with Premera coverage in Western Washington. This led to some patients receiving bills from CellNetix for unexpected, out-of-network fees for certain pathology lab services in 2015 and early 2016. The complaint claimed that Swedish and Providence were responsible for notifying patients that they were receiving services from an out-of-network vendor and may receive unexpected charges.
CellNetix made a commitment to Swedish and Providence that these patients would not receive unexpected bills because of its contract dispute with Premera. Swedish and Providence had also been assured by CellNetix that any billing concerns were being resolved.
Swedish and Providence fully cooperated with the attorney general’s investigation and reached a settlement. Because CellNetix made assurances that its contract dispute with Premera would not affect our patients, CellNetix will make a substantial financial contribution to Swedish and Providence to cover the cost of the settlement.
Under the settlement with the attorney general, we have put procedures in place to ensure that when a vendor like CellNetix falls out of network with a health insurance plan, the vendor cannot send bills for unexpected amounts to patients or the patients will be notified that the vendor is out-of-network with their payer. The settlement allows Swedish and Providence to put this matter behind us, so that we can focus on caring for our patients.
What happened?
- During a contract dispute between Premera and CellNetix, CellNetix became temporarily out of network for certain Swedish and Providence patients with Premera coverage. Some of our patients received bills from CellNetix for unexpected, out-of-network fees for certain lab services as a result.
- The Attorney General of Washington State brought a consumer protection complaint against Swedish and Providence as part of its examination of health care billing.
- Swedish and Providence fully cooperated with the attorney general’s investigation and reached a settlement.
Who does this affect?
- Some patients who received care at Swedish and Providence hospitals and clinics in Western Washington received unexpected bills from CellNetix while it was temporarily out of network in 2015 and early 2016.
- Swedish and Providence were assured by CellNetix that these patients would not receive unexpected bills as a result of its contract dispute with Premera, and that any billing concerns were being resolved.
How will patients know if they are affected?
- Because CellNetix made assurances that its contract dispute with Premera would not affect our patients, CellNetix will identify the affected patients and make a substantial financial contribution to Swedish and Providence to cover the cost of the settlement.
- A third-party administrator will send a one-time, final payment to the affected patients identified by CellNetix.
- Patients who may be affected can direct questions to the third-party administrator, by calling CPT Group at 1-(888) 402-9516.