Irritated. Pissed-off. Disturbed.
That's how I feel after getting an un-cheery letter from Regence BlueCross BlueShield of Oregon letting me know that as of July 1, 2018, Salem Health Professional Services will be leaving their provider network.
So if this happens, I'd have to pay out-of-network rates for (1) the primary care doctor I've had for 13 years, Michelle Rasmussen; (2) a mental health nurse practitioner in Rasmussen's office, Melody Klug, who has been overseeing medication for depression that hit me after I acquired a chronic bladder condition, and (3) Thye Schuyler, a doctor at the Salem Health Sleep Center who found a way to stop nighttime leg cramps that were contributing to my depression.
Today I phoned Regence after noting in their letter, "If you currently receive medically necessary treatment from the provider for an illness or injury and have concerns, please call us so we can help you plan your continued care."
I talked with someone who was pleasant and a good listener. I explained that given a choice between changing my health care providers or changing my Medicare Advantage company, I was much more inclined to switch from Regence MedAdvantage at the earliest open enrollment opportunity.
I also pointed out that while the letter said that Salem Health Professional Services "has been unwilling to negotiate a new contract and continues to demand a double-digit increase in what we pay them for your care," double-digit rate increases were what Regence regularly imposed on me and my wife before we turned 65 and had a private insurance policy.
Also, I told the Regence person that because of the Trump administration's efforts to undermine the Affordable Care Act, I've been reading about health insurance rates in some states going up by 50% or more. So a double-digit rate increase doesn't seem all that unreasonable.
The only possible good news that came out of our conversation was the staffer said that negotiations are continuing with Salem Health Professional Services, so there's a chance I won't have to pay out-of-network rates after July 1 of this year.
Though she probably knew this, I couldn't resist telling the Regence person that Salem Health happens to be by far the largest health care provider in Salem, and there's a considerable advantage in having most of my medical records centralized in one location.
Plus, I've used the Salem Health Urgent Care center several times, and the providers there also would become out-of-network if Regence MedAdvantage can't reach an agreement with Salem Health Professional Services (formerly known as Willamette Valley Professional Services).
The Regence person gave me an example of how much more I'd pay with out-of-network rates. A recent follow-up visit with Melody Klug was billed at $113.91 and Regence paid $103.91, with my co-pay being $10. If I end up having to pay 50% for office visits, the out-of-network rate, my cost would be about $57 (1/2 of $113,91) rather than $10.
Now, I give Regence MedAdvantage credit for actually lowering the monthly premium I pay from $101 in 2017 to $90 in 2018. Of course, I'm sure Regence adjusted its benefit structure accordingly in ways that I'm not prepared to spend time trying to figure out (every year I get a big thick "book" from them that I glance at, but don't study in detail).
It's possible that I'd stick with Regence MedAdvantage even if they don't have a contract with Salem Health Professional Services after July 1, but it's also very possible that I'd decide to switch to a different MedAdvantage provider like Providence or Moda -- assuming one of them covered my Salem Health providers.
I'm just irritated that Regence is on the verge of terminating its contract with the doctors and nurse practitioner I rely on for my health care, since I like the care I'm getting and have no desire to change providers. The letter I got notes "many other high-quality providers" in their network, including Legacy Clinics in Tualatin, Silverton Health, and Stayton Family Practice.
Um, thanks, but no thanks. I live in Salem, not Tualatin, Silverton, or Stayton. And what happened to "if you like your doctor, you can keep him/her"?
Bottom line is that Medicare is way better than private health insurance, but with Medicare Advantage, which I generally like, there's still some complications reminiscent of the not-so-good old days when we were saddled with expensive, cumbersome, bureaucratic private insurance through Regence.