COEUR D’ALENE, ID – A North Idaho hospital and a major Idaho health insurer are struggling to renegotiate a contract to keep the hospital in network.

Kootenai Health and Regence BlueShield of Idaho are “at an impasse” to renegotiate the provider care contract, state officials recently said.

If a deal isn’t struck by Jan. 1, the Coeur d’Alene hospital could become out-of-network for Regence, which runs the health insurance plan for state government employees and several other plans. The contract ending could raise health care costs at the hospital for around 11,000 Idahoans.

Regence and Kootenai Health say the struggle to strike a deal has revolved around setting fair rates for the hospital.

Regence Blue Shield of Idaho’s vice president of network management, Ryan Pharis, said negotiations are still underway.

“Many of these negotiations go unnoticed by the public because the two parties are able to reach that mutually agreeable, common ground at the end,” he told the Idaho Capital Sun in an interview Friday. “… Negotiations are tending to get more complex as we see health care seemingly becoming more and more complex all the time.”

Kootenai Health’s communications and marketing director, Kim Anderson, said the hospital and insurer hope to reach a deal soon.

“Kootenai Health is working closely with Regence BlueShield to renew our contract and ensure continued in-network access for Regence members,” she said in a statement. “Our shared goal is to reach a favorable agreement before the end of the year — one that supports both organizations and protects access to high-quality, local care for our community.”

Who would be affected if the contract ends?

The negotiation “affects all of Regence’s book of business with Kootenai Health,” officials with the Idaho Office of Group Insurance told North Idaho enrollees in the state employee’s insurance plan in a letter Nov. 10.

About 11,000 Idahoans across commercial plans and less than 200 people on Medicare Advantage plans could be affected, Pharis said. About 1,000 members of the state’s insurance plan, which insures state employees and their family members, could be affected, said Idaho Department of Administration spokesperson Kim Rau.

State officials said Regence will on Nov. 24 start notifying enrollees who received care from the Coeur d’Alene Hospital via letters. People with questions should call Regence’s customer service at 1-800-854-5585.

What services would be affected?

Coverage for non-emergency services at the hospital — including inpatient and outpatient surgeries and services — would be affected by the contract’s end, Kootenai Health says.

Some people could continue seeing their providers at in-network rates for 90-days after the contract’s potential end date, if they qualify for continuity of care under federal law, the Idaho Office of Group Insurance explained. That applies for pregnant women, people who are already getting treatment or have some severe health issues, and people who have scheduled surgeries or procedures that aren’t elective.

Emergency care will continue to be covered at in-network rates, because of the federal law called the No Surprises Act, state officials say.

Regence updated its records about which providers are in network and out of network, Rau said.

“We encourage Regence members to log into their Regence portal, visit the provider search tool at Regence.com, or call customer service on the back of their ID card, to determine which providers and facilities might be a good option,” she said. “Options for care will likely include options in the Spokane area, which may be in-network.”

Why the health insurance contract negotiations are struggling

In a blog post dated Nov. 6, Regence said that “Kootenai Health’s leadership issued a termination notice” unless Regence “agree(s) to a double-digit increase that would raise the annual cost of health care in the state by an estimated $15 million.”

While the insurer said it was negotiating in good faith, it was also bracing to be removed from the hospital’s network.

“Over the course of two months, we have made multiple attempts to reach a fair and sustainable agreement with Kootenai Health’s leadership. They have declined all offers and continue to insist on unsustainable increases in what we pay them to care for our members,” Regence said.

Pharis, with Regence, wouldn’t offer specifics on the rates under negotiation.

“The ask on the table from Kootenai Health right now is larger than what they have agreed to in past years,” he said in an interview. “… We have provided data, much of which is from their own transparency data sources that are available to the public, that supports our position and the offers that we have put forth to Kootenai Health.”

On the hospital’s website, Kootenai Health said it was hopeful negotiations would resolve. But in another, also undated, post, the hospital portrayed the contract negotiations as having already failed, saying “Kootenai will no longer be part of the Regence network of hospitals.”

Pharis said the hospital’s statements that said the contract was ending came first, before the hospital softened messaging to say negotiations are still underway.

Kootenai Health’s website notice portraying negotiations as failed says parties couldn’t agree on rates “that are sustainable” for the hospital. “Despite the hospital’s good faith efforts, Kootenai and Regence BlueShield were unable to agree upon mutually acceptable contract terms and rates that are sustainable for Kootenai Health,” the hospital’s website says.

On that frequently asked question page, Kootenai Health said: “We worked hard to reach an agreement with Regence, but their requirements were outside what we could accept in good conscience. In the end, we determined that accepting contract terms with rates below market value is risky, unsustainable for Kootenai Health, and would not be a responsible choice for our hospital.”

This story first appeared on Idaho Capital Sun.