Regence patients could lose coverage at local hospitals, cancer clinic

People with Regence Blueshield of Idaho insurance may have to pay more for services at St. Mary’s Health and Clearwater Valley Health hospitals beginning next year.  

Regence’s contract with the hospitals in Cottonwood and Orofino, respectively, has ended. But people can still receive “in network” care until Jan. 1, said Kim Johnson, director of marketing and communications at St. Mary’s Health.

Regence says it is trying to negotiate a new contract with the hospitals.  

A November statement on the hospitals’ website says Regence’s reimbursement rates were 23% below the average of St. Mary’s Health and Clearwater Valley Health’s other commercial health plan contracts.

Regence media representative Lou Riepl said the company is pursuing a new agreement to bring the hospitals back in-network. 

But Johnson said the insurer’s proposals for the two hospitals so far had been inadequate.

“Despite our best efforts, Regence’s proposals have been unreasonable and unsustainable, leaving us no choice but to proceed without a new agreement,” she said. “Our priority has always been to ensure that patients have access to quality care close to home, and we are hopeful that Regence will return to the table with a fair proposal that meets the needs of both parties, and most importantly our patients, before the end of the year.”

Riepl said Regence has continued to work with the hospitals in hopes of keeping them in network, sending multiple contract proposals including the latest version which was shared the week of Jan. 26.

“As the only health insurer in the state founded by Idaho physicians, balancing the need to reasonably compensate providers while also supporting our commitment to affordable health care for our members is a responsibility we take seriously,” he said. “Both sides coming to the table with a willingness to be flexible and work toward a compromise will get a deal done that addresses our members’ legitimate needs for affordability, while fairly reimbursing both hospitals.”

The change affects all non-emergency care at the hospitals, and all Regence Blueshield health plans, including Asuris, BridgeSpan, Healthcare Management Administrators, Regence Group Administrators, Regence Medicare Advantage, Uniform Medical Plan and any Regence BlueShield of Idaho Commercial Insurance Plan.

Another provider, Cancer Care Northwest, has told Regence policyholders it will be  out-of-network   beginning April 3 unless they reach a new agreement with the insurance provider. 

A representative for Cancer Care Northwest said they were  still trying to  negotiate a contract with Regence, and was hopeful about reaching an agreement before patients lose coverage. 

Still, Tracy Saxton Collins, of Lewiston, said the information made her uneasy.

Collins is in remission from breast cancer, but travels to Cancer Care Northwest for follow-up appointments every six months. 

“My next appointment is two weeks after this deadline,” she said. 

Collins said she’s most worried for patients in the middle of treatment. In-network treatment for people with her health plan leaves patients responsible for 20% of treatment costs, she said, while out-of-network is 40%.

“My very first chemo treatment came in at the $40,000 mark,” she said. “That becomes really significant for people really quickly.”

Patients with further questions about their health plans can contact Regence’s customer service line at (888) 367-2117.