Regence BlueShield Contract with St. Mary’s Health and Clearwater Valley Health

If you have Regence BlueShield of Idaho health insurance, we want to inform you that Regence’s contract with St. Mary’s Health and Clearwater Valley Health hospitals will be terminated effective January 1, 2025. However, there is a continuation period of 12 months from the effective termination date during which time you will still be able to receive “in-network” care. This means beginning January 1, 2026, it may cost Regence members more for our services. We’ve put together this handout to help answer your questions about our contract with Regence BlueShield. You should also contact Regence BlueShield directly with any questions you may have.

 

Q: Why did this happen?

A: Despite the hospitals’ good faith efforts, St. Mary’s Health, Clearwater Valley, and Regence BlueShield were unable to agree upon mutually acceptable contract terms. The reimbursement rates offered by Regence BlueShield are unacceptable due to being 23% below the average reimbursement of St. Mary’s Health and Clearwater Valley Health’s other commercial health plan contracts. The pandemic and inflation have dramatically increased costs for healthcare facilities and Regence BlueShield is unwilling to reimburse St. Mary’s Health and Clearwater Valley Health hospitals at sustainable rates. Both St. Mary’s Health and Clearwater Valley Health hospitals remain committed to providing high quality care and are contracted with many other major commercial health plans in the area.

 

Q: Will Regence be contacting me about this?

It is Regence BlueShield’s responsibility to notify their enrollees that this termination has occurred.  If you have any questions for Regence BlueShield, they can be contacted at (888) 367-2117.

 

Q: I am currently insured by Regence. What does this mean for me?

A: Effective January 1, 2025, St. Mary’s Health and Clearwater Valley Health will no longer be part of the Regence network of hospitals. That means Regence BlueShield of Idaho will consider St. Mary’s Health and Clearwater Valley Health “out-of-network” providers. However, there is a continuation period of 12 months from the effective termination date during which time you will still be able to receive “in-network” care. As a result, you may face higher co-payments, co-insurance payments, and other out-of-pocket costs if you continue to rely on St. Mary’s Health and Clearwater Valley for your health care after December 31, 2025. You should check with Regence BlueShield for coverage determination.

 

Q: Does this mean I can’t receive care at St. Mary’s Health/Clearwater Valley Health?

A: For emergency services, you can continue to receive care at St. Mary’s Health and Clearwater Valley Health hospitals. If you are in the middle of a course of treatment or have a surgery or procedure scheduled, you may be able to continue to have that care at St. Mary’s Health and Clearwater Valley Health hospitals.  In some instances, Regence may cover elective or non-emergency services at St. Mary’s Health or Clearwater Valley Health hospitals.  Contact Regence to determine whether Regence will authorize your care at St. Mary’s Health or Clearwater Valley Health hospitals and what your out-of-pocket costs will be.

 

Q: What services will this affect?

A: Many key services will be affected, including but not limited to any care received at St. Mary’s Health or Clearwater Valley Health hospitals, including all inpatient and outpatient surgeries and services except for emergency care.

 

Q: Does this affect St. Mary’s Health and Clearwater Valley Health clinics and professional services?

A: No, this termination does not affect access to St. Mary’s Health or Clearwater Valley Health clinics and professional services, which remain in network for Regence BlueShield.  Should this change, St. Mary’s Health, Clearwater Valley Health, and Regence BlueShield will notify you in advance of any changes.

 

Q: Are there any Regence plans that are NOT affected?

A: No. All Regence BlueShield plans are affected by this termination. This includes:

• Asuris
• BridgeSpan
• Healthcare Management Administrators (HMA)
• Regence Group Administrators
• Regence Medicare Advantage
• Uniform Medical Plan (UMP)
• Any Regence BlueShield of Idaho Commercial Insurance Plan

 

Q: I live and work here and want local health care. How can I keep seeing my doctor and use St. Mary’s Health/Clearwater Valley Health?

A: Talk to your employer or insurance broker about your health insurance options. Your employer or insurance broker may be able to help you, and allow you to switch to another insurance provider that covers services offered at St. Mary’s Health or Clearwater Valley Health. We are proud of our commitment to accept nearly every insurance plan serving this area. While we may be unable to accept Regence BlueShield insurance in the future, we welcome many other leading health plans.

 

1. My insurance card says “BlueShield” but not Regence. Am I affected?
2. You may be. You should check with Regence to find out if your insurance will be affected once St. Mary’s Health and Clearwater Valley Health hospitals go out-of-network with Regence.

 

Q: What if I’m expecting a baby, have a surgical procedure scheduled, or I’m receiving ongoing treatment for cancer or another medical condition. Will I need to find a new hospital and physicians?

A: If you are in the midst of treatment at St. Mary’s Health or Clearwater Valley health hospitals, you are entitled to completion of that treatment, and Regence is obligated to continue to reimburse St. Mary’s Health and Clearwater Valley Health for that treatment under the terms of our prior contract, until your care can be safely discontinued. You should call Regence directly at (888) 367-2117 with any questions you have on covered services.

 

Q: Where can I go if I need emergency care?

A: In an emergency, you should seek care at the closest facility that can provide that care. As community critical access hospitals, St. Mary’s Health and Clearwater Valley Health are committed to providing care in an emergency situation, regardless of the patient’s ability to pay.

 

Q: Why won’t St. Mary’s Health/Clearwater Valley Health just sign a new contract with Regence?

A: We worked hard to reach an agreement with Regence, but Regence was unwilling to offer reimbursement rates in-line with other commercial payers or what we could accept in good conscience. In the end we determined that accepting a contract that is unsustainable would not be a responsible choice for our critical access hospitals.

 

To reach Regence BlueShield, please call (888) 367-2117.

 

The Idaho Department of Insurance may also have information that may be helpful to you.  The Department may be reached at (208) 334-4250, or you can go online at https://doi.idaho.gov/.