Notice of Contract Changes Effective 1-1-2011 That Will Affect Clients Covered by Regence Blue Shield and the State of Washington Uniform Medical Plan (Updated 10-12-2010)

If you are a prospective client, or a returning client who has not seen Dr. Nix recently, please review the following information carefully: The State of Washington Uniform Medical Plan (UMP) has historically maintained its own network of health care providers, and paid behavioral health providers rates that were some of the most fair and equitable of any health plan in the Pacific Northwest. As a result, state workers and their families who were covered by UMP have had access to a wide selection of psychologists, counselors, and clinical social workers who contracted with UMP as “Preferred Providers”. Because more than half of my clients have been covered by UMP in recent years, and reimbursements were good, I was able to maintain contracts with several other plans that paid consistently lower fees including Regence Blue Shield. Effective 1-1-2011, UMP will be dismantling its provider network, and turning all administrative responsibilities over to Regence Blue Shield. UMP officials have signed an agreement that puts Regence in complete control of provider contracting, and allows Regence to set the rates at which providers will be compensated for services. Because the Regence fee schedule is considered “proprietary information” and Regence has threatened legal action against any contracted provider who releases that information to the public, I am not at liberty to provide you with detailed data about the differences between the UMP and Regence fee schedules. However, I would note that the current Regence contract allows only a few dollars more per session than I was routinely charging and collecting more than 18 years ago. After I confirmed the terms of the new UMP contract with Regence, I did communicate with a Regence contract representative in an attempt to negotiate a fee schedule that might allow me to survive financially while affording my clients with the benefit of “in network” coinsurance rates (currently UMP pays 85% of the “allowable” for contracted providers, but only 60% of the allowable for “out of network” services). I was informed that the Regence Behavioral Health Fee Schedule was not negotiable, and that no exceptions would be made to this policy despite the acknowledged financial “hardship” that disparities between the Regence and UMP fee schedules might create for providers who see a large numbers of UMP covered clients. I was effectively told that I could either accept financial terms that would virtually insure my financial insolvency, or terminate my contract and provide services on an “out of network” basis. While I’m concerned about the potentially negative impact on both my clients and my practice, I will be terminating my contract with Regence effective 1-1-2011. My services will still be covered at the “out of network” rate for clients with UMP coverage, and I’m hoping that most of my clients covered by Regence will also have “out of network” benefits. If you are currently insured by Regence, please visit my “Downloads” page and review the information I’ve provided to help current and prospective clients determine how contract changes will affect their coverage. Because my financial policy is different for “out of network” insurance coverage, I’ve also provided a memo detailing this information and discussing ways that we can work together to address increasing coinsurance amounts that may be challenging for some clients. The patience and solution-focused collaboration of my current clients is much appreciated during this time of transition. I hope that these contract changes will not be a significant deterrent to prospective new clients or returning clients who would like to schedule an appointment. Please do not hesitate to contact me with any questions or concerns if you’re unsure how these changes might affect you. Sincerely, Jan L. Nix, Ph.D.