PeaceHealth Files Suit, Accusing Trillium, Health Net Of False Advertising
PeaceHealth has filed suit against Trillium Community Health Plan and its affiliate, Health Net Health Plan of Oregon, alleging the two insurers engaged in false advertising by touting their Medicare Advantage plans for 2020 as including PeaceHealth as an in-network provider.
In its complaint filed in U.S. District Court in Eugene, PeaceHealth asked the judge to order Trillium and Health Net to immediately stop their “false statements and misrepresentations” to health insurance brokers and others.
Eugene-based Trillium and Tigard-based Health Net have not yet responded to the lawsuit, which was filed Oct. 14. A spokesperson for the two insurers did not respond to a request for comment from The Lund Report.
Both insurers are owned by Centene Corp., a Fortune 500 Medicaid and Medicare insurer based in Missouri.In its complaint, PeaceHealth said that in April it clearly notified Trillium and Health Net that it was leaving their Medicare Advantage in-network roster effective Jan. 1, 2020. But since then, the insurers have “falsely represented to (health insurance) brokers that Health Net and Trillium were in discussions with PeaceHealth regarding PeaceHealth’s contract status for the 2020 (Medicare Advantage) plans.”
Medicare Advantage is a comprehensive health insurance plan for those 65 and over. Open enrollment for next year started Oct. 15 and runs until Dec. 7.
PeaceHealth said it has been contacted by more than 35 health insurance brokers in recent days who were misled by Trillium and Health Net and wanted to know whether the PeaceHealth system would be in-network for Trillium and Health Net in 2020.
Many brokers and purchasers of health insurance give great weight to whether a provider is in-network. Having a provider in-network makes is much easier and cheaper for the consumer. If a consumer unwittingly uses an out-of-network provider, they can be stuck with hefty bills. Listing PeaceHealth as an in-network provider would make Trillium’s and Health Net’s policies more attractive to policy buyers, PeaceHealth said.
Trillium, Health Net Will Be 'Out Of Compliance'
In its lawsuit, PeaceHealth said that under Medicare rules, sellers of Medicare Advantage insurance need to include a set number and type of in-network providers.
Without PeaceHealth, “Health Net and Trillium will be out of compliance with regulated network adequacy standards in Lane County,” PeaceHealth wrote.
Trillium has 2,394 Medicare Advantage members, according to the latest figures compiled by Oregon insurance regulators. Health Net has 36,392 Medicare Advantage members.
According to the lawsuit, PeaceHealth has for years signed annually renewable Medicare contracts with Trillium and Health Net that listed PeaceHealth facilities in Oregon and Washington as in-network providers. PeaceHealth has 10 medical centers and a large network of clinics in the Pacific Northwest.
But PeaceHealth in its complaint said that in numerous letters and telephone discussions from April 16 onward, PeaceHealth notified Trillium that it would not renew those contracts for the period starting Jan. 1, 2020.
“PeaceHealth decided to not renew its in-network agreements with Health Net and Trillium for 2020 (Medicare Advantage) plans because renewal was not consistent with PeaceHealth’s goals to improve care delivery, improve overall patient experience and decrease administrative burdens,” PeaceHealth wrote in the complaint.
PeaceHealth has kept many other insurers as Medicare Advantage providers, however. For 2020, in Clark County, Washington, home to PeaceHealth’s Vancouver headquarters, PeaceHealth will be in-network for Aetna, Community Health Plan of Washington, Humana, Kaiser Permanente Northwest, Molina, Providence, Regence and United.
In Lane County, PeaceHealth will be in-network for Medicare Advantage in 2020 with Moda Health, PacificSource, Providence, Regence and United.
Torrent Of Letters, Phone Calls
PeaceHealth said it told Trillium and Health Net about the non-renewal by letter and in a phone conversation on April 16; at a meeting on June 18; at a meeting on July 24; in a Sept. 30 phone conversation with Chris Hummer, the new CEO of Trillium and Health Net; in letters on Oct. 1 directing Trillium and Health Net “to stop misrepresenting that PeaceHealth would be an in-network provider under the 2020 (Medicare Advantage) plans;” in an Oct. 4 phone call with Hummer; in an Oct. 8 meeting with Hummer; and in a “cease and desist” letter sent Oct. 9.
However, Trillium continued to suggest to health insurance brokers and others that PeaceHealth would or might be an in-network Medicare Advantage provider in 2020, the lawsuit alleged.
For example, in the Oct. 4 phone call, Hummer requested a “brief meeting” with the new president of PeaceHealth, the lawsuit said. PeaceHealth agreed to the meeting but “stated unequivocally” that it would not discuss the 2020 Medicare Advantage plans.
PeaceHealth later determined that at an Oct. 8 presentation to brokers, Trillium and Health Net gave “the impression” that PeaceHealth might still agree to become in-network, telling brokers that Trillium and Health Net was meeting with PeaceHealth that afternoon and “would inform brokers of the result of that meeting,” the lawsuit said.
At the Oct. 8 meeting of PeaceHealth and the two insurers, PeaceHealth “again stated unequivocally” that PeaceHealth would not be in-network, the Vancouver-based nonprofit alleged.
But as of Oct. 11, Trillium and Health Net had not notified brokers of that, the lawsuit said.
In September, Trillium and Health Net had “misrepresented” in a meeting with about 100 brokers that PeaceHealth would be in-network, PeaceHealth alleged. Also, in its “2020 Medicare Advantage” broker training manual, as of Sept. 24, PeaceHealth facilities were listed as in-network for “2019/2020,” according to the lawsuit.
Consumers Are 'True Victims'
PeaceHealth said it fears consumers may buy Medicare Advantage policies under the misconception that PeaceHealth will be in-network.
“The true victims of Trillium’s and Health Net’s scheme will be the thousands of innocent insureds who sign up for Trillium’s and Health Net’s 2020 (Medicare Advantage) plans because they have been misled to believe that PeaceHealth will be an in-network providers,” the lawsuit said.
Trillium’s and Health Net’s promotional materials “are intended to unlawfully associate” the two insurers with PeaceHealth and “unlawfully capitalize on PeaceHealth’s goodwill, reputation and market position,” the lawsuit said.
PeaceHealth is asking a judge to order Trillium and Health Net to publish on their websites and issue a news release stating that PeaceHealth will not be an in-network provider in 2020.
You can reach Christian Wihtol at [email protected].
Oct 16 2019