SAMARITAN HEALTH &
PREMERA NEGOTIATIONS

update: november 20, 2023

Premera & Samaritan reach a deal

Samaritan Healthcare and Premera have come to an agreement on a 1-year contract, providing no disruption to Premera patients receiving care at Samaritan Hospital or clinics. This 1-year contract is effective through December 31, 2024.

The new contract allows members to retain in-network access to healthcare services in 2024. Discussions on a long-term contract continue.

update: November 9, 2023

Samaritan has terminated their contract with Premera effective December 31, 2023. While both parties work towards reaching an agreement, the parties remain far apart. If a new agreement cannot be reached, your doctor may be considered out-of-network and you will have to pay higher cost shares for non-emergency care starting  January 1, 2024.

In-network vs. out-of-network

In-network providers are doctors, other health care providers, and hospitals that Premera contracts with to provide medical care to its members. In-network providers agree to reimbursement levels for certain services and write off the difference between billed amount and the contracted amount (allowed amount). You just pay your copay, deductible, or coinsurance.


A provider that isn't contracted with Premera is called an out-of-network provider. Out-of-network providers may bill Premera (or you) and Premera pays the amount they would have paid had the provider been in-network. You pay higher cost shares AND you are responsible to pay for the difference of billed amount and the amount Premera paid (balance billing).

You can continue seeing your doctor, even if your doctor becomes out-of-network, but I’ll cost you more!

get prepared by locating in-network doctors

Locate doctors not part of Samaritan Healthcare and Association of Samaritan Physicians

  • Download the list of providers who will remain in-network even if Samarian and Premera do not reach agreement. If your provider is not on this list, your provider will become out-of-network on January 1, 2024 if no agreement can be reached.

  • Visit Premera’s website and browse doctors in the Heritage & Heritage Plus Network near you

  • Call Premera at 800-722-1471 to help you find a doctor near you.

  • Check out Kinwell primary care for in person (Wenatchee, Pasco, Spokane) or virtual visits

Register with these telehealth providers

  • Doctor on Demand (general medical, dermatology, behavioral health) — $10 copay

  • 98.6 (general medical health) — $10 copay

  • Talkspace (behavioral health) — $10 copay

  • Boulder Care (addiction treatment) — $10 copay

understand how you are affected when you receive

Emergency care:

  • You can still receive emergency care at any emergency department. Emergency care is always covered at the in-network cost. Wherever you receive emergency care, laws protect you from surprise (or balance) billing.

Ongoing care:

  • You may be able to continue your care at your current provider at the current in-network benefit level for up to 90 days if you are receiving treatment for a covered service or for a complex or chronic medical condition, including pregnancy or scheduled non-elective surgery.

  • Contact Premera customer service at 800-722-1471 for more information about this process.

Member notification

Premera is required to notify anyone who may be impacted by the loss of in-network coverage 30 days prior to the end of the contract with Samaritan. If a settlement cannot be reached, letters will arrive in your mailbox by December 1 and will include transition information and additional support for members with serious or chronic conditions. Member notification does not mean that negotiations have broken down but rather follows the law of written notification.

Grant PUD and CWPU UIP urge Samaritan Healthcare
to come to an agreement with Premera

On November 1, Tod Ayers - Grant PUD, Jody George – UIP Chair, and Sylvia Hubbard - UIP Benefits Program Administrator met with Samaritan Healthcare’s Chief Administrative Officer urging ongoing negotiations with the goal to reach settlement before January 1, 2024, reiterating the importance of access to health care and cost impact to you and your family if Samaritan Healthcare’s doctors and facilities become out-of-network.

background

Since March 2022, Premera and Samaritan have been working in good faith to renegotiate contracts and as part of the negotiation process, Samaritan Healthcare issued a termination notice to Premera. Please be assured that both parties continue to work together to renegotiate their contracts with the intent to provide continued access to affordable, quality healthcare. Confluence, Providence, and recently University of Washington have provided notice of contract terminations and in all cases, the parties settled on a new multi-year contract prior to termination date.

your cost impact

In the unlikely event that an agreement cannot be reached, Samaritan Healthcare and clinics (facilities) and Association of Samaritan Physicians (Samaritan-employed doctors/providers) will become out-of-network. While you still can see out-of-network providers, higher cost shares will apply. For example, if you are enrolled in the PPO plan, rather than paying a $25 copay, your cost for an office visit would be $25 copay, then 30% coinsurance, plus the difference between the allowed amount and amount billed by the provider (balance billing). If you are enrolled in the CDHP plan, you would need to meet your deductible, then 40% coinsurance plus balance billing. The out-of-pocket maximum does not apply to out-of-network services.

What if I have a long-term treatment plan, have a chronic medical condition, or are scheduled to deliver a baby?

If you are receiving treatment for a covered serious, complex, or chronic medical condition at any Samaritan Healthcare facility, you may qualify for continuity of care benefits. This includes pregnancy, long-term or chronic illness, or a scheduled nonelective surgery. If approved, you can continue your care at Samaritan Healthcare at the current in-network benefit level for up to 90 days after contract termination.

What if I need emergency care?

 You will still be able to get emergency care at Samaritan Healthcare facilities. Emergency care is always covered at the in-network cost under the No Surprises Act. Wherever you receive emergency care, you are protected from surprise (or balance) billing by state or federal law. This means the most the provider or facility may bill is the plan’s in-network cost-sharing amount (copays, deductibles and coinsurance) and you cannot be billed for any costs above the in-network rate.   

What happens next?

Through December 31, 2023, regardless of ongoing negotiations, you can receive care from Samaritan Healthcare providers and associated facilities on an in-network basis. Beginning January 1, 2024, if a new agreement is not reached, non-emergency care will cost more out of pocket if you receive care from Samaritan Healthcare providers and facilities. Premera can work with you to find another in-network doctor or health care professional and safely move your care. If you would like more information on doctors in your area, you can use the Find a Doctor tool or call Premera at (800) 722.1471.       

Click here to learn more about the process behind provider negotiations.