More than 7,000 Blue Cross of Idaho members in Kootenai County will have to participate in the Kootenai Care Network if they want to get Blue Cross insurance next year, reports The Spokesman-Review.
This means Blue Cross policyholders in the county must have surgeries at Kootenai Health's hospital in Coeur d'Alene, Idaho, and choose from a list of 450 healthcare providers in the Kootenai network, according to the article. Among the providers not in the Kootenai Care Network are hospitals in nearby Spokane, Wash., or Northwest Specialty Hospital in Post Falls, Idaho.
The move to the new care network model applies to Blue Cross members who purchase ACA policies through Idaho's health marketplace exchange, according to the report. Many members with individual policies also were notified of the move.
Blue Cross of Idaho is the oldest health insurer in the state, with roughly 25 percent of Idaho's population enrolled in its traditional, PPO, and managed care programs, the company website states. Commercial plans offered by employers are not affected, but they might be considered for inclusion in the network in the future, Peter Sorensen, Blue Cross' director of consumer business, told The Spokesman-Review.
He told the publication Blue Cross adopted the network model due to how expensive it was to treat patients newly insured through the ACA.
However, according to the report, out-of-network providers have expressed concerns about losing business from Blue Cross patients, and view the network as a potential power grab by Kootenai Health. About 40 percent of Kootenai Care Network's in-network providers are directly employed by Kootenai Health, while the other 60 percent are independent, according to the report.