Little hope remains that executives at St. Joseph Regional Medical Center in Lewiston and Regence BlueShield of Idaho will resolve a dispute that could cost consumers thousands of dollars before a deadline tonight at midnight.
At issue is how much St. Joe’s charges Regence for the medical care Regence customers receive at the hospital or from its employees, which include a number of physicians, nurse practitioners and physician assistants.
The hospital has sent a termination letter to Regence, stating that its in-network status with Regence will end at midnight tonight, said Lou Riepl, a spokesman for Regence, in an email.
Regence has sent four proposals to the lead negotiator at LifePoint Health, the private Tennessee company that owns St. Joe’s.
“To date, LifePoint has not shown an inclination to pursue a middle ground with us,” he said. “Still, we remain committed to arriving at an updated agreement that hospital leadership agrees fairly balances their needs with the affordability concerns of the broader community.”
St. Joe’s has a different perspective.
“In recent years, Regence has consistently charged patients more and more for their monthly health insurance premiums, while reimbursing St. Joseph less each year for the care our team provides,” said Samantha “Sam” Skinner, a spokeswoman for the hospital, in an email.
“This is unfair to patients and unsustainable for our hospital,” she said.
Absent a last-minute resolution, the impasse means that the more than 15,000 people Regence insures in the area will generally pay substantially more than they do now if they are treated at the hospital or by hospital staff.
After the deadline, most care will be billed as out of network for Regence customers, other than that for emergencies, such as heart attacks, strokes, gunshot wounds, rooftop falls or severe vehicle accidents.
Regence typically reimburses at higher percentages for in-network care than out-of-network care.
Plus, St. Joe’s could “balance bill” Regence customers for services they receive at St. Joe’s whether or not Regence defined them as in network or out of network.
If, for example, a surgery costs the hospital $25,000 and Regence has determined its allowed cost for that procedure is $20,000, Regence would base its reimbursements to its customer on $20,000.
The hospital could bill the Regence patient the remaining $5,000, which would not be offset by any Regence payment.
Skinner has declined to be specific about if the hospital will balance bill Regence patients.
“Every patient bill will be evaluated on a case-by-case basis,” she said.
Regence has been working with customers already diagnosed with cancer or who are delivering babies close to the deadline to make special arrangements.
After the deadline, Regence customers will have to leave the Lewiston-Clarkston Valley to receive chemotherapy or deliver babies at in-network providers.
Palouse Oncology & Hematology in Moscow is in the Regence network. It has one oncologist. The clinic is a collaboration of the hospitals in Moscow, Pullman, Colfax and Cancer Care Northwest.
The closest Regence in-network hospitals to the Lewiston-Clarkston Valley where women can deliver babies are Pullman Regional Hospital and Gritman Medical Center in Moscow.
Other types of care are available in-network for Regence customers at a variety of places, such as Tri-State Memorial Hospital in Clarkston, Valley Medical Center in Lewiston, Tri-State’s Clearwater Medical in Lewiston and Lewiston Orthopedics.
Williams may be contacted at email@example.com or (208) 848-2261.