A lawsuit filed Friday by Seattle Children’s Hospital aims to prevent sick patients from delays and disruptions from critical care.
It claims the Washington State’s Office of the Insurance Commissioner fails to offer adequate network coverage, leaving the hospital off four of the six plans offered by the Washington Health Benefit Exchange. According to the hospital, nearly 60,000 kids are covered under it.
“All it takes is one child to come through here with a diagnosis of cancer or needing a specialized surgery or specialized outpatient procedure that we do here to have a very negative impact,” said Dr. Sandy Melzer, Seattle Children’s Senior Vice-President.
Without being included in the plan, Dr. Melzer says families of current patients are worried about whether they can continue to afford treatment.
“To take an organization like ours and essentially exclude us from the care networks and groups of kids in the exchange is very problematic,” said Dr. Melzer.
Anne Guadagno has two granddaughters, ages six and eight. She sides with the hospital.
“I would want my grandchildren to have the doctor they’ve become accustomed to and are comfortable with. A child that’s been with a certain doctor and nurse and an office needs to stay there,” said Guadagno.
The Office of the Insurance Commissioner plans to investigate the hospital’s claims.
“We take the concern of access to care seriously and are committed to ensuring all consumers can get the care they need. We are reviewing Children’s petition to see what lies at the heart of their concerns and will see how it gets resolved through the legal process,” said Stephanie Marquis, public affairs spokesperson.
As one of the premier provider specialized pediatric services in the Northwest, the hospital says the impact of this lawsuit is bigger than just Washington state.