Regarding Premera Out-of-Network Reimbursements

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By Lucy A. Homans, Ed.D.

I have confirmed that as of January 1, 2017  all Premera individual insurance plans being sold on the Washington Health Exchange will not have an out-of-network benefit.

One group employer based plan, the EPO plan, also will not have out of network benefits as of January 1, 2017, but the traditional PPO plan will continue to have out of network benefits. Additionally, all Premera “grandfathered” policies, that is all insurance plans that enrollees choose to continue with during open enrollment this year, will continue to offer out of network benefits.
This means that if you are an out of network provider for Premera (ie. you don’t have a network provider contract but do submit bills to Premera for reimbursement) you will have to be diligent in asking clients who are Premera enrollees for confirmation that they have a plan offering out of network coverage. If not, and they want to see you, they will have to pay you your full fee directly.