Blue Cross of Idaho requested the Idaho Department of Insurance investigate Nutex Health after months of failed negotiations with Nutex’s Post Falls (Idaho) ER & Hospital, according to a Nov. 17 news release.
The insurer expressed concern over the hospital’s use of the No Surprises Act, which aims to protect patients from unexpected bills for out-of-network providers, often during emergencies. Hospitals under Nutex, an emergency care service provider, are generally considered out of network for Blue Cross of Idaho.
Historically, Nutex strove to submit 60% to 70% of billable visits to arbitration monthly, something the payer highlighted in its release. While the No Surprises Act has cut out-of-pocket costs, providers tend to have more success with arbitration.
“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% of Medicare rates,” Blue Cross of Idaho Chief Strategy Officer Drew Hobby said. “In one instance, we received a claim for nasal congestion that was $2,872 to treat a runny nose. The median commercial rate is $376 for that service.”
In a statement shared with Becker’s, Nutex said, “they follow federal rules.”
“The NSA achieves [its goal] by relieving patients from financial liability for surprise bills and creating an independent dispute resolution process for billing disputes between providers and insurers,” a Nutex spokesperson said. “The IDR process safeguards providers by promoting fair reimbursement from payers, helping ensure their continued ability to deliver care. Post Falls ER & Hospital honors all in-network benefits for emergency services according to the federal No Surprises Act.”
Blue Cross of Idaho is recommending members consider alternative providers for emergency and urgent care.
