Legacy Health possible departure from Uniform Medical Plan (UMP) network

By
Derek VanSpoor
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0
91

From the Washington State Health Care Authority

No network agreement

Regence and Legacy Health have been unable to reach an agreement and as of today, Legacy Health is out of network for UMP members, starting April 1, 2026, with some exceptions. Both parties remain committed to continuing discussions to resolve this negotiation.

Plans and facilities not affected by this negotiation

  • Legacy Silverton
  • Legacy Health Plan
  • Blue HPN

Continuation of Services (CoS) for Legacy Hospitals only

Members will be able to continue receiving care at Legacy Health hospitals at in-network rates and benefits for an additional 12 months, through March 31, 2027, under a special provision in our contracts with Legacy Health. CoS does not apply to Legacy providers or clinics. Legacy has shared a guide to help members understand which providers are available at in-network or out-of-network rates and benefits as of April 1, 2026.

Recently, Regence BlueShield (the administrator for UMP) mailed a legally required notice to approximately 5,200 PEBB and SEBB Uniform Medical Plan (UMP) members about an upcoming potential provider network disruption. The mailing states that Legacy Health may no longer be in the UMP network starting April 1, 2026.

HCA understands that all parties continue to negotiate in hopes of reaching an agreement before the current contract expires. If a new network agreement is reached, UMP members will receive another letter from Regence informing them of this result. HCA will update this announcement as negotiations continue.

What do I need to do if I receive the notice?

  • You do not need to take any action right now.
  • Any care and services you have scheduled through March 31, 2026, will still be covered at the in-network rate.
  • Check this page for updates, keeping in mind that most of the time a new network agreement is ultimately reached without any provider network disruption occurring.

What if an agreement is not reached?

On or after April 1, 2026, members receiving services from Legacy Health will pay the out-of-network rate, which is 40% of the allowed amount, plus any amount the provider bills that is above the plan’s allowed amount.

Emergency care received at any hospital emergency room would still be covered at the in-network rate. If you need immediate help, call 911 for a hospital emergency or 988 for a mental health or substance use disorder crisis.

UMP members currently receiving services from Legacy Health for certain conditions may have the right to continue treatment at the network rate for a limited time under a continuity of care provision. You can visit the Regence news page for the most up-to-date information on contract negotiations and continuity of care.

Eligible conditions for continuity of care include:

  • Seeing the provider for a serious or complex condition, including certain chronic conditions.
  • Undergoing a course of institutional or inpatient care from the provider.
  • Being scheduled for a nonelective surgery from the provider.
  • Being pregnant and seeing the provider for pregnancy-related care.
  • Being determined to be terminally ill.

Check your plan’s certificate of coverage (COC) for more information or call UMP Customer Service at one of the numbers below.

I have Medicare as my primary insurance; how will this affect me?

If Medicare covers the care that you are receiving from Legacy Health and Legacy Health is a Medicare-participating provider, your care with Legacy Health will continue to be considered in-network with both Medicare and your secondary coverage under UMP. If Medicare does not cover the care you are receiving from Legacy Health, your care from Legacy Health on or after April 1, 2026, will be paid at the out-of-network rate by your UMP Plan.

Who can I contact for help?