I'm a Regence Medicare Advantage member, so have been following the dispute between Regence and Salem Health with considerable interest.
But if I wasn't aware of it before, a full page Regence ad in last Sunday's Statesman Journal (April 21) made the contract impasse difficult to miss. Heck, it was two-thirds the length of our dog!
The headline said, "Salem Health is asking for a bigger raise than you can afford." And down at the bottom, "Salem Health is demanding a double-digit increase that you can't afford."
Right now I'm not going to believe what Regence says, nor am I going to believe what Salem Health says. Choosing sides between a massive health insurance organization and a massive health care provider is a lot like being offered a choice between brussel sprouts and artichoke hearts.
I don't like either one.
But until the United States gets with the rest of the industrialized world and offers us citizens a cost-effective way to obtain health care without going through the maze of administrative bullshit that even Medicare is prone to (though Medicare is way better than private insurance), I'm going to have to keep on dealing with Regence and Salem Health.
On the whole, I'm siding with Regence in this dispute. Here's one reason why.
Last year I got a November 6, 2018 letter from Regence regarding my Medicare Advantage plan. It said that the contract between Regence and Salem Health would end on December 31, 2018. However, Regence went on to say:
"However, to help protect our Medicare Advantage members from high out-of-pocket costs, we have made the business decision to provide in-network benefit coverage through December 31, 2019. This means you should not experience any change in coverage if you receive care from the hospitals [Salem Health and Salem Health West Valley] through Dec. 31, 2019. Your in-network benefit will apply."
That was good news.
I appreciated that Regence sent out the letter well before the end of the annual open enrollment period, October 15 to December 7, during which I could have changed Medicare Advantage plans. I've been generally happy with Regence Medicare Advantage.
However, on December 21, 2018 Salem Health Hospitals & Clinics sent me a letter with a different message. After noting that Salem Health's contract with Regence for professional services (care provided by health care practitioners) expired on June 30, 2018, the letter said:
A separate contract with Regence continues to cover Salem Health's hospital facility bills through June 30, 2019. This means that our physician and other professional services are only covered under your out-of-network insurance benefit, while our hospital facilities will continue to be covered for in-network services until June 30, 2019.
Now it's hard for me to believe that Salem Health wasn't aware that Regence had told its Medicare Advantage members that Regence would bill at in-network rates for care provided by Salem Health hospitals through December 31, 2019. Thus it seemed that the December 21 letter from Salem Health was a scare tactic.
If so, it worked.
Shortly before an upcoming repeat colonoscopy on February 12, I got to thinking about how much more it would cost if I had to pay Salem Health for hospital care at out-of-network rates. Sure, Regence had told me I'd be paying at the in-network rate through the end of 2019. But the Salem Health letter said that the in-network rate would end June 30, 2019.
So I phoned Regence. A note I scribbled on the November 2018 letter from Regence says "Called 2/7/19. Was told this letter is correct. Salem Health was wrong."
I also was told by the Regence person I talked with that they'd gotten lots of calls about the discrepancy between what Regence said in its letter and what Salem Health said in its letter -- which, again, was wrong. Or at least, deeply misleading.
The way I understand the situation, it seems that while the contract between Regence and Salem Health for hospital services ends either on December 31, 2018 (according to Regence) or June 30, 2019 (according to Salem Health), in either case Regence has agreed to bill at the in-network rate until the end of 2019.
I have no idea why Salem Health chose to mislead Regence members.
Yes, the in-network contract was going to end, but Regence apparently was going to absorb the cost of the difference between in-network and out-of-network rates for all of 2019. So I and many other Regence Medicare Advantage members got needlessly worried when we got the December 21, 2018 letter from Salem Health.
This whole thing reminds me of the pissing match that's been going on between DirecTV and the Pac-12 Networks for more years than I can remember. DirecTV says the Pac-12 Networks is asking for too much money. The Pac-12 Networks says other TV providers have paid what they're asking, so why can't DirecTV?
In between sit DirecTV customers, like me, who couldn't care less about who's right and who's wrong. We just want to see our favorite Pac-12 teams on our television. And the last I looked, the subscriber cost being fought over is less than a dollar a month.
Likewise, a Salem Reporter story, "Patients caught in the middle as Regence, Salem Health dispute rate increase," says:
Regence leaders said the health system is seeking “double-digit” increases to current prices, which would be passed on to customers in the form of higher premiums.
Salem Health leaders have not disputed that figure, but said the move would bring Regence in line with what other commercial insurers pay.
...Neither side has been willing to publicly state the precise amount of the increase or what Regence currently pays for care. Regence has repeatedly claimed Salem Health is more expensive than Oregon hospitals of “similar size and quality.”
Parr said Salem Health has offered to have an independent accountant look at the hospitals rates for other commercial insurers to ensure Regence isn’t paying more. Regence has declined, calling it a “negotiation tactic to drive up the cost of care for our members,” spokesman Jared Ishkanian said.
Geez. I wish both the Regence and Salem Health negotiators would take a big dose of MDMA, a.k.a. Ecstasy, and swear endless love toward each other, then come up with a contract that's agreeable to both sides.
Not having taken Ecstasy, my mood as I write this blog post is considerably less positive toward both Regence and Salem Health.
Like I said above, it's irritating that Salem Health was willing to send out false/misleading information to Regence Medicare Advantage members about a shift to out-of-network hospital rates midway through 2019.
And it's been irritating to have Regence tell me that it's no big deal if I can't use Salem Hospital -- there's hospitals in Silverton and Tualatin that Regence has contracts with.
Hey, Regence: I live in Salem! If I need hospital care I don't want to go to an out-of-town hospital.