Five things to know about provider negotiations

By Regence
woman on couch

Many factors contribute to the cost of your health insurance premium, including payments Regence makes to doctors, clinics or hospitals for our members’ medical care. As contracts for what we pay providers for care come close to ending, providers reach out to negotiate new rates. In some cases, providers are asking for rate increases mid contract and it is increasingly common that suggested rates are in the double digits and unsustainable for Regence to agree to. When this occurs, the provider system can send us a termination notice, essentially telling us that they plan to end their contract, sometimes as we continue to work diligently on reasonable rates. We don’t like it when our members are put in the middle of these negotiations and have needless worry about whether their doctor will be covered by their health plan. Ensuring our members have access to high-quality, cost-effective care is our top priority.

1. How are insurance dollars spent?

About 85 cents of your premium dollar is spent directly on member care such as regular doctor office visits, hospitalizations and prescriptions.

2. How will a provider termination affect my care?

You may still receive care from your provider at the in-network rate until the termination date is effective. After that date, some members may be eligible for continued care for a limited period of time. For members not undergoing continued care, once a provider goes out of network, they may make you pay more for your health care.

3. Are there alternative options available to me?

We’re committed to ensuring our members have access to the care they need. Our network includes many providers that share our commitment to high-quality, cost-effective care. You can search for in-network providers at or call our customer service professionals at the number on the back of your member ID card.

4. How could a provider termination affect my wallet?

If we are unable to reach an agreement with a provider and they leave our network, they could make you pay more for services.

5. What about emergencies?

In an emergency, members should always seek care at the closest hospital. Care for an emergency medical condition will be covered as in-network (even if the member doesn’t otherwise have out-of-network benefits), though their out-of-pocket costs will vary depending on their health plan benefits.