PeaceHealth ‘streamlines’ Medicare partners


Trillium Medicare Advantage and Health Net no longer included in insurance coverage

Nov. 2, 2019 — PeaceHealth hospitals, including Peace Harbor Medical Center, will no longer be accepting Health Net and Trillium Medicare Advantage plans starting Jan. 1, 2020. The insurance plans will still be accepted throughout 2019, but if patients do not move to a different plan during the annual Medicare Open Enrollment period, which ends Dec. 7, insurance coverage will be cut off.

“As part of our ongoing efforts to streamline our Medicare partners and provide high quality, affordable care to our communities, PeaceHealth is not renewing its contract with Centene’s Health Net and Trillium Medicare Advantage plans in 2020,” PeaceHealth representatives said in a statement provided to the Siuslaw News.

They stressed that PeaceHealth is not pulling out of Medicare Advantage plans altogether. Instead, PeaceHealth will be accepting plans from Moda Health, PacificSource, Providence, Regence and United.

“Our patients remain our top priority, and we are committed to supporting them during this transition,” a PeaceHealth representative said.

Open enrollment for new insurance lasts from now until Dec. 7, where patients with Trillium and Health Net can switch to one of the approved providers. To help with the transition, Peace Harbor has informational booths in the main hospital lobby Monday through Friday, now through Dec. 6.

Agents will be on hand to answer questions and help patients enroll during the remainder of the open enrollment period.

PeaceHealth will also have a Medicare Insurance Helpline available at 866-391-7750 throughout open enrollment to help patients.

The breakup between the longtime medical services partners has been somewhat acrimonious throughout the year. PeaceHealth first started providing Medicare Advantage plans with Health Net back in 2004, and with Trillium in 2012. Both insurers are owned by Centene Corporation.

According to PeaceHealth, last April, they informed both insurers that they were no longer renewing their contract and would, instead, work with other providers for Medicare Advantage. Details surrounding the decision are unknown, with PeaceHealth reiterating, “This is part of our ongoing efforts to streamline our Medicare partners,” when asked by the Siuslaw News about the decision.

Centene Corporation did not return a request for comment.

However, since April, Health Net and Trillium have allegedly been misrepresenting the split to insurance brokers, stating that negotiations were still ongoing. Both providers’ websites still listed PeaceHealth as “in-network” on their websites as well.

Because of this, many patients were unaware of the split until October, when they began receiving letters from PeaceHealth offering new plans. Many patients were confused by the news, with some worrying that PeaceHealth was pulling out of accepting Medicare Advantage altogether.

On Oct. 14, PeaceHealth sued the two insurers, saying in a statement that consumers will “likely not learn PeaceHealth is not an in-network provider until they attempt to get care from PeaceHealth and are either turned away or receive a much larger bill. At that point, open enrollment will be over and the consumers will not be able to purchase a different policy until open enrollment in October 2020.”

On Oct. 28, the federal judge over the case ordered the two insurers to alert consumers that Medicare plans for 2020 will no longer include PeaceHealth, stating, “The public has a right to know that the largest provider in the regions at issue will no longer be ‘in plan,’ and the time to be so informed is during open enrollment.”

The judge required Trillium and Health Net to include a banner headline on the front page of their websites informing all patients of the change.

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