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Essentia in talks to join Sanford Health Plan provider network

Essentia Health

By Patrick Springer / The Forum

 Essentia Health has not yet joined the provider network for the health insurance plan that will cover an estimated 65,000 North Dakota public employees, retirees and their family members starting July 1.

The board of the North Dakota Public Employees Retirement System, commonly called NDPERS, voted Feb. 19 to switch its health insurance coverage from Blue Cross Blue Shield of North Dakota to the Sanford Health Plan.

Administrators at Essentia Health and the Sanford Health Plan expect to meet next week to discuss Essentia joining the insurance plan’s provider network.

“Representatives of both Essentia and Sanford Health Plan have reached out to one another, and we will meet March 12 to begin 

initial discussions,” said Cindy Morrison, executive vice president at Sanford Health.

Jennifer McLaughlin, a spokeswoman at Essentia Health, confirmed that negotiations are pending with Sanford Health Plan concerning a contract to join the provider network.

“Obviously, since it is in its very early stages, that’s all the information I have at this time,” she said.

More than 90 percent of health providers in North Dakota are in the Sanford Health Plan network, and those that aren’t have an open invitation to join, according to the Sanford Health Plan.

The Sanford Plan, associated with Sanford Health, North Dakota’s dominant medical provider, entered the state’s health insurance market in 2010. As medical providers, Essentia Health and Sanford Health are rivals.

Adequacy of the provider network, meanwhile, is among the provisions of draft legislation that is circulating in the Capitol that Rep. George Keiser, R-Bismarck, is considering introducing.

The bill draft also requires that health insurance benefits coverage “may not disrupt existing nor impede future provider relationships with insureds.”

Keiser has said that he wants to ensure there are no changes in coverage over the next two years. Legislators, along with state employees, are among the public employees covered by NDPERS.

Keiser couldn’t be reached Wednesday for comment on the bill draft.

Jon Strinden, a Fargo lawyer and chairman of the NDPERS board, has been in contact with legislative leaders about the health insurance switch to discuss their concerns.

If legislation is introduced concerning the health coverage switch, NDPERS representatives would like to provide input. Strinden said he did not view any legislation as an attempt to “derail” the planned switchover.

“They want to protect the interests of the participants and the other stakeholders in the plan,” he said, adding the interests of the NDPERS board and legislative leaders appear “in alignment.”

The Sanford Health Plan still has almost four months to strengthen its provider network before the insurance switchover July 1, Strinden said.

He reiterated that health insurance benefits will not be altered when the change in insurance carriers is made, a switch that will end 37 years of coverage by Blue Cross Blue Shield of North Dakota.

Sanford has given assurances that its health provider system and health insurance plan are separate entities governed by separate boards, and do not share information, one of legislators’ concerns, Strinden said.

Participation of medical providers in the Sanford Health Plan’s network is a top concern regarding the health insurance switch among members of North Dakota United, which represents many public employees in the state, Nick Archuleta, the organization’s president, said Wednesday.

“It’s the No. 1 concern that we’ve been hearing,” Archuleta said, noting that most of the concerns have come from members in the Fargo area.

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