Recently I got a not-so-cheery letter from Cheryl Nester Wolfe, President and CEO of Salem Health Hospitals and Clinics.
She informed me, along with many thousands of other people in Salem who get their health insurance through Regence Blue Cross Blue Shield of Oregon that Salem Health's contract with Regence expires on December 31, 2024 and "despite repeated attempts to negotiate a new contract for 2025, Regence refuses to agree to fair market terms."
Wolfe put most of another sentence in boldface to draw attention to it.
This means that as a patient, you will likely be responsible for a greater portion of the costs of your care at all Salem Health Hospitals and Clinics locations after December 31, 2024.
Yesterday the Salem Reporter had an informative story about this dispute, "Salem Health seeks 35% increase from Regence in insurance coverage dispute." Here's how the story begins:
Thousands in Salem may not be able to get in-network care at Salem Health next year due to a contract dispute between the hospital system and insurance company Regence BlueCross BlueShield.
Both sides say the disagreement, centered around how much the insurance company pays Salem Health to care for patients, may be insurmountable.
Salem Health is seeking a 35% increase in the amount it bills Regence when members go to the emergency room or have surgery at Salem’s only hospital.
Hospital leaders said that’s necessary to keep up with inflation, while Regence said it would drastically raise premiums for members.
If a deal isn’t settled, Regence patients would pay more out-of-pocket for appointments, surgeries and care at Salem Health’s hospitals and clinics.
Federal law protects patients from paying out-of-network prices for emergency care, including airlifts.
This is really annoying. I'm on Medicare, so have the Regence MedAdvantage plan. The monthly cost is reasonable, $72 a month. I've been happy with the plan, which I've had for ten years, ever since I became eligible for Medicare.
I got a MedAdvantage plan in part because just before I turned 65, I semi-jokingly asked my Salem Health family physician if she was going to kick me out after I had Medicare, since I knew that medical providers complain about Medicare's reimbursement rates. She said that her clinic loses money on regular Medicare visits but they break even, or maybe a bit better, with MedAdvantage.
Today I phoned Regence, being more than a little concerned about the statement in the Salem Reporter story that the disagreement between Regence and Salem Health may be insurmountable. The open enrollment period for MedAdvantage plans ends December 7, so I wanted to start looking into other options if Regence and Salem Health can't agree on a 2025 contract.
The woman I talked with at Regence was pleasant and seemingly knowledgeable. She told me that contract disputes happen all the time between insurance companies and providers, but usually they aren't as public as this one. She said that if Regence doesn't have a Salem Health contract by November 18, I think it was, they'd have to send out a letter to their Salem customers stating this.
I told her that since my deadline is December 7 to sign up for a different MedAdvantage plan, that's cutting it kind of close. She then told me that between January 1 and March 31 Medicare allows one switch of MedAdvantage plans, which often occurs because someone chooses a new plan during the fall open enrollment period, then finds they don't like that plan.
This applies even if no change has been made to a MedAdvantage plan. Meaning, I could dump Regence and enroll in a different plan between January and March. However, she added that the change doesn't take effect until the first of the next month after a change is made, which means I could have no MedAdvantage plan at all for a while if I switched from Regence early next year.
I don't want to run that risk, given the ever-present possibility of a serious accident or illness popping up. So I'm strongly leaning toward switching to a different MedAdvantage plan prior to December 7. My wife has Providence MedAdvantage through her PERS retirement health plan. She likes Providence, though no insurance plan is perfect.
Understand: I don't trust either Regence or Salem Health.
I told the woman at Regence who I talked with today that this reminds me of the disputes that regularly surface with DirecTV, which we have to use because we live in a rural area lacking cable. When, say, ESPN goes off the air due to a lack of a contract, DirecTV says it is because ESPN is being greedy, and I should complain to ESPN. Of course, ESPN says it is because DirecTV is being greedy, and I should complain to DirecTV.
My attitude is that I don't care who's at fault, I just want ESPN back so I can watch sports. Likewise, I don't care who's at fault between Regence and Salem Health, I just want health care.
It's crazy that even after joining Medicare, I still have to deal with corporate contract disputes. Our country's health care system is screwed up. Even if we had Medicare For All, so long as the profit motive dominates, patients are going to suffer from giant corporations arguing about how much money each of them is going to make.
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