Workers at PeaceHealth feel their access to health care is limited with new insurer

When employees at PeaceHealth hospitals around the state need a prescription filled for themselves or a family member, they can get them filled at PeaceHealth pharmacies for lower costs. It’s one of the benefits of the health care organization’s insurance plan for its employees.

But in Bellingham, Washington, PeaceHealth workers can’t use that benefit. There isn’t a physical PeaceHealth pharmacy in the city.

So nurses like Jen Hampton have turned to using the PeaceHealth mail-order pharmacy, which works great for regularly occurring prescriptions, but not for one-time needs.

“ I can’t wait three to five days to get that antibiotic for my child if they need it,” Hampton said.

The intention of this pharmacy benefit hasn’t panned out for PeaceHealth employees in Bellingham. Health care staff there say the benefits have been worsening. Now, many are upset over the new insurance plan that the company moved employees onto starting on Jan. 1.

PeaceHealth, a private not-for-profit Catholic health organization with five hospitals in Washington and others in Oregon and Alaska, notified employees in September 2024 that the company would be creating a customized insurance plan with Moda Health.

At first, some employees were excited about the change, hopeful it would bring back providers through the Family Care Network. 

In 2024, the company’s insurer, United Medical Resources, a subsidiary and third party administrator for United Healthcare, stopped working with the Family Care Network. That meant employees lost the ability to see providers they’d seen for years.

Robin Cully, a co-chair for the Washington State Nurses Association Local at PeaceHealth St. Joseph Medical Center in Bellingham, was one such employee. Because of that, Cully started using his wife’s insurance, which meant higher premiums each month for his family. But Cully said that the access to more options for care has been worth it.

Still, he and others were hopeful that when PeaceHealth started insuring employees through Moda, they would have access to those providers again. On set Moda plans, the Family Care Network is included in the coverage. 

But with the customized plan PeaceHealth created, the Family Care Network is explicitly not covered. 

“ It’s like PeaceHealth didn’t hear us,” Hampton said. “They didn’t hear people say, ‘We want our Family Care people back.’ They’ve gone ahead and completely disregarded that.”

In response to questions about why the Family Care Network was not included in the custom plan, Alison Taylor, system director of strategic communications for the organization wrote, “The customized care network was designed to reflect PeaceHealth’s well-being philosophy, offering innovative solutions that improve access and meet the unique needs of our caregivers,” and “PeaceHealth’s network includes other high-quality providers that offer access to services provided by organizations like (Family Care Network).” 

Kelly Skahan, an attorney for the Washington State Nurses Association, said in conversations between the company and the union, PeaceHealth’s representative expressly called the decision “good business.” 

“ They’ve said that it is a good business decision for them to drive their employees back to them, to use PeaceHealth, and recapture that revenue,” Cully said.  

On the company’s FAQ regarding the insurance transition, it is stated that “When you choose PeaceHealth and ZoomCare for your care, you help sustain our Mission and make a positive contribution for our community of talented caregivers, physicians and clinicians.”  

According to the nurses’ collective bargaining agreement with PeaceHealth, the union and company are able to bargain over benefits like medical insurance if there are significant changes in coverage. It is the union’s position that there are, but the company has said there are not.

Under the new insurance plan options, there are three tiers of providers, with employees paying the least out of pocket to see Tier I providers. PeaceHealth and ZoomCare, a chain of clinics also owned by PeaceHealth, are Tier I providers. Since there isn’t a  ZoomCare in Whatcom County, Bellingham employees have fewer options.

“It’s nice that PeaceHealth calls it a benefit, we just can’t access it,” Hampton said.

Taylor addressed the lack of that access for  Bellingham employees, writing,“While ZoomCare clinics are not located in Whatcom County, caregivers can access some ZoomCare services virtually. If needed, ZoomCare coordinates with community resources to complete necessary labs/imaging.”

Since employees are incentivized to go to PeaceHealth providers because of the lower costs, their options for providers are limited, employees said. Hampton said she’s heard from colleagues who are waiting months to see a doctor, or are having to travel as far as Vancouver, Washington, to find a covered specialist for their medical needs.

PeaceHealth has set up a priority scheduling line for caregivers to access appointments with providers, but Cully said that has not been working. 

There’s also the fact that some health care workers don’t feel comfortable seeking medical care at the place they work because of privacy concerns. Cully said it feels like being forced to shop at the company store whether or not you want to. 

Moda Health directed NWPB to PeaceHealth for questions, and the company did not answer how common it is for entities to create customized insurance coverage options. On PeaceHealth’s FAQ regarding the insurance transition,“PeaceHealth and Moda Health worked together to develop a highly customized care network, which is not Moda’s standard network structure.” 

The union and company began bargaining for the nurses’ next contact on Jan. 21.