With less than 30 days until Portneuf Health's contract with Regence BlueShield of Idaho expires, the Pocatello hospital is sharpening its public case against the insurer.
Portneuf Medical Center on Monday issued a news release stating Regence denies 75.9 percent of claims the hospital says it appropriately submits and that Regence's parent company owes the health system more than $30 million in unpaid claims.
In the statement released Monday, PMC said it remains committed to reaching a fair agreement before the June 15 deadline, but made clear that major sticking points go well beyond reimbursement rates.
If no deal is reached, thousands of Southeast Idaho residents who carry Regence insurance could lose in-network access to PMC and its affiliated providers, likely resulting in significantly higher out-of-pocket costs for most non-emergency care.
The new figures add detail to a dispute that has been building publicly since late April. PMC says Regence's Portland, Oregon-based parent company, Cambia Health Solutions, is also proposing contract terms that would under-reimburse PMC by more than $60 million, and that the health system is already being paid significantly less than what Regence pays other health systems in the market.
Despite those gaps, PMC said it has put forward a modest, single-digit rate increase as part of a longer-term agreement designed to provide stability for patients and employers — a characterization that stands in contrast to what Regence and state officials have previously described. The Idaho Office of Group Insurance said earlier this month that Ardent Health, PMC’s Tennessee-based parent company, had initially sought a 73 percent increase over seven years and most recently proposed a 41.6 percent increase over five years — figures Regence described as more than double the rate of inflation.
PMC’s statement Monday did not address those figures directly. Instead, it focused on what it called disruptive practices by Regence that it says are harming patients and driving up costs, including claim denials, down coding and repeated reprocessing requirements that the health system says delay care and create unnecessary administrative burdens.
"These practices directly impact Portneuf's ability to sustain local access to care," Portneuf said in the statement.
The health system pointed to its role serving seniors, Medicaid beneficiaries and other vulnerable populations regardless of their ability to pay, and said fair and timely reimbursement is essential to maintaining the staffing, technology and facilities needed to serve the region.
Regence has maintained that it cannot accept the rate increases being demanded by Ardent executives and that accepting them would drive up premiums for local businesses and health plan members. The insurer has also identified alternative in-network hospital and clinic options for members in the event a contract isn't reached, including Bingham Memorial Hospital in Blackfoot, Mountain View Hospital in Idaho Falls and several Pocatello-area primary care clinics such as Primary Care Specialist.
Federal law requires emergency services to be covered at in-network rates regardless of contract status, and patients who are pregnant or undergoing active treatment for serious conditions may qualify for continuity of care protections under the No Surprises Act.
Both sides have said they continue to negotiate in good faith. PMC is directing Regence members to portneuf.org/network-update for information on coverage options and continuity of care resources. Regence members with questions can call the number on the back of their member ID card or visit regence.com.