Idaho hospital's ER physicians out of network with state's largest insurers


Pocatello, Idaho-based Portneuf Medical Center's emergency room physicians are out of network with the state's two largest health insurers after the ER physicians reorganized under a new group, according to the Idaho State Journal.

The ER physicians created a new practice, Rocky Mountain Physician Group, to move management from an out-of-state group into their own hands. However, this required the physicians to negotiate new contracts with Blue Cross of Idaho and Regence BlueShield of Idaho.

Now, Blue Cross and Regence BlueShield members are facing higher medical bills for getting treatment from RMPG physicians, as negotiations have been unsuccessful. However, RMPG physicians are optimistic that if new contracts are signed, they will be retroactive and reimburse patients for any out-of-network charges.

In a notification to members, Regence BlueShield allegedly said RMPG had not told them about the management switch, and blamed the physicians for any occurrences of balance billing, according to the Idaho State Journal. Blue Cross told the publication: "The previous emergency room physician group at Portneuf Medical Center reorganized under a new name, and did not notify Blue Cross of Idaho until recently. We have had discussions with the new group; unfortunately, they want a significant rate increase. Their request is inconsistent with our commitment to provide affordable healthcare to our members."

RMPG contends it attempted to contact both insurers ahead of the switch to request new contracts.

RMPG said it was disappointed by Regence's letter, and said it is looking for a "fair and reasonable market rate for physician services," Bill Carns, COO of RMPG's administrative agent, said. "To date, Blue Cross of Idaho has not responded with a reasonable proposal."

More articles on payers:
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Blue Cross to offer North Carolina members up to $500 rebate for choosing cheaper physician
Anthem expands AI, automation agreement with IBM

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