KAILUA-KONA — Queen’s Health Systems hospitals are no longer considered participating providers within Kaiser Permanente’s network after an agreement between Kaiser and The Queen’s Medical Center expired at the end of last month.
Kaiser members will still have access to and be covered for emergency and trauma services at all Queen’s Health Systems hospitals, as they would at any hospital, said Kaiser Permanente spokesperson Laura Lott. And members with a current referral to a Queen’s hospital “generally will not have their course of treatment interrupted and will continue to receive treatment.”
The hospital services agreement between Kaiser and Queen’s expired May 30 and the two entities “have not been able to reach agreement on a new contract,” said Mich Riccioni, chief financial officer at The Queen’s Health Systems.
Starting May 31, he said, services at Queen’s hospitals for Kaiser members “will be billed at non-participating provider rates.”
Kaiser members impacted include Medicare Advantage members, Medicaid members, QUEST Integration members and commercial members.
North Hawaii Community Hospital in Waimea, which became a part of The Queen’s Health Systems in January 2014, is one of the hospitals affected. The Queen’s Medical Center — Punchbowl, The Queen’s Medical Center — West Oahu, as well as Molokai General Hospital also are affected.
Kona Community Hospital, Kohala Hospital and Hilo Medical Center are not affected, as they are under Hawaii Health Systems Corp. Those are identified as “affiliate locations” on Kaiser Permanente’s website.
Lott said the agreement between Kaiser and Queen’s was for five years, and negotiations for a new one have been ongoing since late 2017.
“Usually in Hawaii, the hospitals and the health care systems all work together because we are so isolated, because we need to work together,” she said. “So this has been very disappointing.”
Lott said about 1,300 Kaiser members received care last year at North Hawaii Community Hospital, although given that many of the visits to Queen’s hospitals are for emergency care, she couldn’t say exactly how many people will be affected by the expired agreement.
She emphasized that members will still have access to emergency and trauma services at all Queen’s hospitals, and those services will be covered. Once a patient is stabilized, she said, determinations on follow-up care will be made by the provider and Kaiser collaboratively, “and with the member’s input, too, of course.”
For new referrals, Lott said, Kaiser will prioritize sending members to an in-network provider.
“We are evaluating referral options for members who have an existing referral but have not yet begun treatment,” she said. “In consultation with the member, we will elect to either maintain the referral or to provide an equal alternative.”
She said there also are also cases where people will still be referred to a Queen’s Health Systems hospital, including North Hawaii Community Hospital, such as when a service is exclusively available there. And in cases where patients are referred there, those services will be covered.
Lott added that Kaiser Permanente members with questions about their coverage or benefits can call its neighbor island line at 800-966-5955.
Email Cameron Miculka at email@example.com.