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Saturday, March 6, 1999 - Page updated at 12:00 AM

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Insurance Carriers Criticized For Suit

Seattle Times Staff Reporter

The two insurers that filed lawsuits yesterday against Insurance Commissioner Deborah Senn should get out of the courtroom and fix their problems in the emergency room, the commissioner's head of enforcement said.

Regence BlueShield and Premera Blue Cross, the state's two largest health insurers, say Senn broke the law by failing to provide information to the companies before blasting them at a news conference for denying emergency-room claims.

Jeffrey Coopersmith, the commissioner's head of enforcement, said the state's insurers have ignored the law and hurt the public.

"The insurers complain we didn't give them notice," said Coopersmith, also chief counsel for the commissioner. "Well, you know, we don't tell the burglar we're about to charge him with a crime . . .

"What this is really about is, the carriers are angry. And they're angry because they got caught."

Senn said Tuesday the state's four largest health-care carriers should have approved more than half the claims they denied in the first four months of 1998. She wanted Premera, Regence, Qualmed Washington and Aetna U.S. Healthcare to pay the old claims and stop denying new ones.

Flanked by doctors, Senn estimated that 7,000 of the 14,000 denials were illegal under a law that went into effect in January 1998.

That law says that if a "prudent layperson" considers his or her condition an emergency, then emergency-room care must be provided and covered by insurers.

Regence and Premera officials say Senn violated a different law by going public before giving insurers a chance to review her examination.

Insurers have gone to court in the past over rates and technical issues. But these lawsuits, filed in Thurston County Superior Court, are the first that accuse Senn of violating the law, according to the insurers.

Company officials also say Senn sparked fears and withheld information that could have helped insurers solve problems.

"We think her approach to us this week . . . caused unnecessary panic among our members," said Chris Bruzzo, a Regence spokesman.

Together, Regence and Premera insure about 2 million people in Washington.

Health-plan officials say they're not sure whether Senn's information is correct because they haven't seen it.

"I can tell you we believe we're following the law," said Teresa Moore, a Premera spokeswoman.

Insurers said they have repeatedly asked Senn for proof backing up her announcement about emergency-room denials.

Coopersmith said he spent nine months investigating the denials, using the companies' reports.

"We're trying to protect the public and keep the doors open at emergency rooms," he said.

Kim Barker's phone message number is 464-2255. Her e-mail address is: kbarker@seattletimes.com

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

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