Regence patients could lose coverage at area hospitals, cancer clinic

St. Mary’s Health & Clearwater Valley Health hospitals have notified patients with Regence BlueShield of Idaho health plans that they should expect to pay out-of-network costs.

The contract with the hospitals in Cottonwood and Orofino ended Jan. 1, but has a continuation period of 12 months after the end date in which patients who are covered by Regence will still be able to receive “in network” care, said Kim Johnson, director of marketing and communications at St. Mary’s Health.

Patients should reach out to Regence directly to understand what is and is not covered in their individual situation, Johnson said.

According to a November statement on the hospitals’ website, the reimbursement rates offered by Regence were 23% below the average reimbursement of St. Mary’s Health & Clearwater Valley Health’s other commercial health plan contracts.

A Regence media representative said the insurance company was still pursuing a new agreement to bring the hospitals back in-network.

However, 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.”

The change affects all nonemergency 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 regional provider, Cancer Care Northwest, in January notified patients they had not yet reached an agreement with Regence of Idaho, and would be out-of-network for the insurance provider beginning April 3 if they failed to do so.

The letter also stated Regence of Idaho had not provided reimbursement increases to the clinic since 2018.

A representative for Cancer Care Northwest said the provider was still working to negotiate an updated contract with Regence, and was hopeful about reaching an agreement before patients lose coverage.

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

Collins is in remission from breast cancer, but still 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.”

Sun may be contacted at rsun@lmtribune.com or on Twitter at @Rachel_M_Sun. This report is made in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.