Women who become pregnant and people who are diagnosed with cancer in the future could be among those hardest hit by a dispute between St. Joseph Regional Medical Center and Regence BlueShield of Idaho.
The Lewiston hospital will no longer participate in the Idaho insurance plans of Regence as of Jan. 15, unless the two sides can reach a compromise before then.
At issue is how much St. Joe’s charges Regence for the medical care Regence customers receive at the hospital. The prices are set in a contract between Regence and St. Joe’s, following a common practice in the health care industry.
Regence is one of the biggest insurance providers in the region, covering more than 15,000 people in north central Idaho.
St. Joe’s is the largest hospital in the area and the only place that delivers babies and offers chemotherapy in the Lewiston-Clarkston Valley. It is also part of LifePoint Health, a private business based in Tennessee that operates a network with dozens of hospitals in almost 30 states.
In the absence of a resolution, Regence would continue to provide in-network reimbursement for emergency treatment at St. Joe’s for conditions such as heart attacks or injuries sustained in serious automobile accidents after Jan. 15, said Regence spokesman Lou Riepl in an email
Generally, other care St. Joe’s offers, including obstetrics, chemotherapy and office visits to physicians who are hospital employees, would be considered out of network after Jan. 15, if St. Joe’s and Regence can’t reach a settlement, Riepl said.
That means that Regence would reimburse the customer based on the price it has set for a certain service. If St. Joe’s charged more than that, the difference would be the patient’s responsibility.
In the short term, the hospital and the insurance provider are trying to reach an arrangement that would allow women in the later stages of pregnancy and people already being treated for cancer at St. Joe’s to be reimbursed at in-network rates.
St. Joe’s and Regence are encouraging patients to contact Regence’s customer service department to get information about continuity of care benefits.
“Patients who are currently receiving treatment will likely have continued in-network access to St. Joseph physicians and services,” St. Joe’s spokeswoman Christina Metcalf said in an email.
Regence has a similar position.
“We will make every effort to continue treatment at their current facility at the same in-network benefit amount until a safe and appropriate time when we can explore alternative options,” Riepl said.
One group would be insulated from the impasse between St. Joe’s and Regence for at least one year.
Those enrolled in Regence’s version of Medicare Advantage would receive in-network benefits through 2020 at St. Joe’s.
Medicare Advantage is the federal name for coverage offered by a number of insurance providers that some seniors opt for instead of Medicare.
This is the first time that Regence has negotiated its contract with St. Joe’s since the hospital switched from a not-for-profit to a for-profit model in May 2017.
While the State Department of Insurance, which oversees Regence and other insurance providers, is following the situation, the agency hasn’t indicated what, if anything, it will do if the stalemate lasts.
“We do want to emphasize ... that every carrier has the responsibility to meet standards outlined in Idaho code ... including providing coverage for good quality health care services, which will be and are readily available to its insureds,” agency spokeswoman Jennifer McClelland said in an email.
St. Joe’s and Regence both contend they are seeking a fair agreement.
“Regence reimburses (St. Joe’s) below (the) market average for the care our physicians and other team members provide,” Metcalf said.
“As the region’s only Level III trauma center, we must have the resources to care for patients’ most critical needs,” she said. “We are working to obtain a new, fair agreement for our services that allows ongoing reinvestment in patient care, enhanced services and facilities and recruitment of new caregivers.”
Regence has a different stance.
If Regence were to agree to what St. Joe’s has proposed, annual premiums would rise by several hundred dollars to more than one thousand dollars per household, Riepl said.
“As a nonprofit ... insurer, we’re directly accountable to our members,” Riepl said in an email. “They expect us to negotiate the best rates possible for quality health care. We’ve never been asked by our members to pay more for care so they could pay higher premiums.”
What happens next depends on Regence and St. Joe’s. Both sides have indicated they are still talking.
“We have every reason to believe Regence also wants to reach a new agreement and we are working with them in good faith,” Metcalf said.
Williams may be contacted at firstname.lastname@example.org or (208) 848-2261.