Blue Cross said the company isn’t letting them give in-network care at the hospital and is abusing the arbitration process.
POST FALLS, Idaho — Blue Cross of Idaho said Monday that it sent a letter to the Department of Insurance to investigate Nutex Health Inc’s. business model and its use of the independent dispute resolution process.
Blue Cross is the state’s largest health insurer and Nutex Health is a for-profit health care company based in Houston. Its hospital division includes Post Falls ER and Hospital that opened last year.
“Over the past year, Blue Cross of Idaho has made good-faith efforts with Post Falls ER & Hospital to come into network for our members in North Idaho,” said Drew Hobby, chief strategy officer for Blue Cross of Idaho, in a press release. “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-percent of Medicare rates.”
Hobby said in one instance, they received a claim for nasal congestion that was $2,872 to treat a runny nose.
“The median commercial rate is $376 for that service,” he said.
Blue Cross officials said in the release that Nutex is utilizing the “No Surprises Act” arbitration process with the goal of submitting 60-70% of visits to arbitration, despite its recognition of the cost of such arbitration.
Between April 17 and Oct. 28 of this year, Blue Cross of Idaho said it received about 2,800 negotiation requests related to treatment at Post Falls ER and Hospital, an average of about 75 new requests per week.
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