Blue Cross of Idaho seeks investigation

POST FALLS — Blue Cross of Idaho said Monday that it sent a letter to the Department of Insurance to investigate Nutex Health Inc's. business model and its use of the independent dispute resolution process.

Blue Cross is the state's largest health insurer and Nutex Health is a for-profit health care company based in Houston. Its hospital division includes Post Falls ER and Hospital that opened last year.

"Over the past year, Blue Cross of Idaho has made good-faith efforts with Post Falls ER & Hospital to come into network for our members in North Idaho," said Drew Hobby, chief strategy officer for Blue Cross of Idaho, in a press release. "Unfortunately, Post Falls ER & Hospital rejected our offers to agree to fair, in-network rates and has elected to continue seeking payments through the independent dispute resolution process that often exceed 1,000-percent of Medicare rates."

Hobby said in one instance, they received a claim for nasal congestion that was $2,872 to treat a runny nose.

"The median commercial rate is $376 for that service," he said.

Blue Cross officials said in the release that Nutex is utilizing the "No Surprises Act" arbitration process with the goal of submitting 60-70% of visits to arbitration, despite its recognition of the cost of such arbitration.

Between April 17 and Oct. 28 of this year, Blue Cross of Idaho said it received about 2,800 negotiation requests related to treatment at Post Falls ER and Hospital, an average of about 75 new requests per week.

Nutex Health issued a press release Monday evening that it follows federal rules as it applies to the No Surprises Act and that Post Falls ER and Hospital honors all in-network benefits for emergency services according to the federal No Surprises Act.

"Congress enacted the No Surprises Act effective Jan. 1, 2022, to protect patients from surprise medical bills incurred when they receive emergency medical services from out-of-network healthcare providers," the release said. "The No Surprises Act achieves this by relieving patients from financial liability for surprise bills and creating an Independent Dispute Resolution process for billing disputes between providers and insurers. The patient is not involved in this process and payment is issued directly to the provider. The Independent Dispute Resolution process safeguards providers by promoting fair reimbursement from payors, helping ensure their continued ability to deliver care."

Hobby said that access to high-quality, affordable health care is the main goal of Blue Cross and that this alert has been made in efforts to bring attention to the situation.

Blue Cross is encouraging members in Post Falls and the surrounding areas to seek alternative locations for emergency or urgent care

Blue Cross of Idaho and Post Falls ER and Hospital are not the only ones trying to reach an agreement for in-network insurance coverage.

As of Nov. 7, Kootenai Health announced it is working with Regence BlueShield to renew its contract and ensure continued in-network access for Regence members before the end of the year.

Kootenai Health officials stated they are optimistic that ongoing discussions will lead to a resolution that aligns with industry benchmarks and supports the sustainability of care. If a new agreement is not reached by Jan. 1, Kootenai Health may be considered out-of-network for Regence members.

"This means that if you have Regence insurance, it may cost you more out-of-pocket to receive care from Kootenai Health," said a letter from Kootenai Health.