Salem Health cancels patient appointments after Regence split

In the weeks since Salem Health stopped accepting Regence BlueCross BlueShield insurance, patients continue to find themselves stuck in the middle with canceled appointments and a lack of alternatives outside of Salem’s only hospital. 

Among them is Ernie Shippen, 91, who was diagnosed with Parkinson’s disease at Salem Health three months ago. It’s a complex condition that affects the brain and movement, and treatment can include a combination of medication, physical therapy and speech therapy.

He and his wife, Peggy, liked the Salem Health Parkinson’s specialist they’d met, who put him on a new medication. He had a follow-up appointment scheduled for July.

Shortly after Salem Health announced on Feb. 19 that it would no longer accept Regence insurance, the Shippens got a call from the doctor’s office: their appointment with the only Parkinson’s specialist they could find in the city was canceled.

“I said, ‘Well, okay, we don’t mind paying the extra out-of-network cost,’” Peggy Shippen said, and that Regence had told them they’d pay some of the cost, too. “She puts me on hold… she says ‘Nope. We are not doing business with Regence anymore, whatsoever.’”

Even when patients with Regence insurance are willing to pay cash for their care, Salem Health is in most cases canceling existing appointments rather than allowing people to pay out of pocket. It’s the latest headache for patients amid the contentious fallout between the hospital and insurance provider.

The dispute between Salem Health and Regence first went public in October, when Salem Health said it was seeking a 35% increase over two years for the amount it bills Regence for patient care, which it said would keep up with inflation from multiple years, and bring Regence up to par with what other insurers are paying. Regence indicated it offered a 3.4% increase aligned with the state’s Health Care Cost Growth Target for the year. Neither party moved far from those figures over weeks of negotiations, ultimately leading to the end of a contract between the two on Jan. 1.

Patients who spoke with Salem Reporter and posted complaints on social media said they are struggling to find adequate care and getting stuck in an endless loop of phone calls between the two parties. Many said they’re getting conflicting information about whether they’re covered or not.

Peggy Shippen said she started to think about their future after that call. Her hips are beginning to bother her, but her old provider at Hope Orthopedics is now part of Salem Health, too.

For Ernie’s Parkinson’s treatment, they may try to get in with the specialist at Oregon Health and Science University in Portland. She said switching his insurance hasn’t been possible so far, because of his expensive diagnosis, and they’ll next attempt a combination of paying through Medicaid and out-of-pocket.

“With 30,000 (Regence patients) who have, in this area, one hospital to rely on: Salem Health, where are all these people going to go?” she said. 

Salem Health’s Chief Financial Officer James Parr said that’s largely up to Regence.

“Regence have been very clear that they don’t need Salem Health in their network to provide adequate care in the community. Now, some Regence members may not agree with that, but that is Regence’s stance,” Parr said. “By definition, that means we can’t treat those patients outside of emergency care and continuity of care.”

Continuity of care is federal law allowing certain types of patients to pay in-network prices even if their insurer doesn’t have an agreement with a hospital. They include pregnant patients, patients getting specialized care over a long period of time such as radiation therapy and scheduled non-elective surgeries.

Several patients told Salem Reporter they called Regence and were told that they were covered by that and can keep their appointment, then called Salem Health and were told they aren’t, and can’t.

Regence provides Salem Health with the list of patients that qualify, Parr said, which he said had been about two weeks behind until very recently, causing the difference in answers.

Parr said they deny patients who aren’t on that list because they don’t want to get it wrong and stick patients with a huge bill. So far, he said only about 500 patients have been named.

“We’ve demanded that they send us that continuity of care information daily,” Parr said. “We want to provide continuity of care. There’s zero incentive for us not to provide continuity of care.”

In response to a question about communication efforts between Salem Health and Regence to prevent patients from having to serve as intermediates for their own coverage, Regence spokesman Dean Johnson said in an email to Salem Reporter that Salem Health “indicated early in the process they felt the law didn’t require them to help identify those patients that qualified for continuity of care.”

Salem Health disagrees with that claim, spokeswoman Lisa Wood said in an emailed statement to Salem Reporter Wednesday. 

“Salem Health works collaboratively with Regence to manage this process; however, Regence has made this very challenging due to sporadic updates of patient lists with incomplete, duplicative, and/or inaccurate information,” Wood said.

Salem Health shared several letters between the two parties from the last two weeks showing their efforts to confirm which patients qualify, and their attempts to add patients to the list.

“As previously requested, Salem Health needs confirmation that this is a complete list of ‘continuity of care’ approved patients since this is far less that the 900 patients Regence indicated in the media,” Phillip Armstrong, Salem Health’s director of contracting & payer relations wrote in a March 3 letter to Regence.

That figure was an estimate previously shared with Salem Reporter by Dr. Zak Ramadan-Jradi, Regence’s vice president of network management, in an article published on Feb. 20. He’d previously said in January that a few thousand qualified.

In the letters from the past month, Regence acknowledges Salem Health’s efforts to collaborate.

Johnson blamed Salem Health for the conflicting answers patients are getting.

“We have told Salem Health on multiple occasions to stop canceling appointments for our members who qualify for continuity of care. It raises compliance concerns with applicable continuity of care requirements. We will continue to help our members find and access in-network care and we will continue to engage Salem Heath to ensure that they are (compliant) with our intent,” he said.

One of the letters shared by Salem Health, dated Feb. 24, confirms that Regence asked them not to cancel such appointments, and asked them to review the latest version of the continuity of care list from Regence before doing so. 

Another letter from Ramadan-Jradi to Parr, dated Feb. 24, asks Salem Health to stop proactively canceling appointments, calling it a retaliatory negotiation tactic.

Canceling appointments

Parr said the decision to cancel most other existing appointments will save patients money in the long run and prevent people from putting off an inevitable transition to a different provider.

“Insurance is covering nothing,” he said. “It’s not fair or right for people to have to pay for health care twice. So they’re already paying for it once through insurance premiums that they’re either paying directly to Regence, or they may be paying through their employer to Regence, and then they come to receive services from Salem Health and they have to pay again 100% out of pocket.”

And, he said, one appointment tends to lead to another, with Salem Health physicians making referrals in-network with other Salem Health specialists.

“You may be able to say “I’d like to pay cash for this one visit with this one physician,’ but if you need anything else, you’re very rapidly going to get trapped into a health care system that Regence says ‘We have no business with Salem Health anymore’ and so those bills will just become bigger and bigger,” he said.

Reporting by the Portland health care publication The Lund Report found that Oregon’s large insurance companies, including Regence, have made big profits in recent years.

Salem Health is among Oregon hospitals saying they’re seeing higher costs and lower revenues in recent years. In January, CEO Cheryl Wolfe was among the speakers at a press conference asking legislators to fully fund Oregon Health Plan, the state’s Medicaid program, and increase hospital reimbursements for maternity care to help cover services.

“We can’t afford to contract with a low-rate insurance payer,” Parr said. 

Who gets in-network coverage at Salem Health?

One of the few points Salem Health and Regence agree on is that anyone who has a medical emergency should go to Salem Health’s emergency room. Federal law protects patients from paying out-of-network prices for emergency care, including airlifts.

Defining who qualifies for continuity of care, where they can keep appointments for an ongoing condition like cancers or a pregnancy, has proven more complicated.

Dr. Tracy Muday, executive medical director for Regence BlueCross BlueShield of Oregon, said that, in the simplest terms, people who qualify for continued care are those in an active course of treatment which started before Dec. 31, the day the original contract ended.

Parr said that the contract failure with Regence is unprecedented territory for Salem Health, and has required extensive readjustment.

“We’re not shooting from the hip, here. We have put hundreds of hours into making sure that we’re identifying which patients are continuity of care, or there’s some exception reasons where we’re going to go ahead and treat them,” he said. “That’s not the majority of patients.”

Salem Health has also developed its own internal algorithm to help decide who gets to keep their appointments in addition to Regence’s list, said Jennifer Fowler, Salem Health’s vice president of finance and service line operations.

Fowler said they worked with around 50 experts to make it and are trying to be as fair as possible. She said they’ve worked to keep some types of patients not included in Regence’s list, like people in their first trimester of pregnancy or mid-treatment oncology patients.

Muday, at Regence, said their goal is to make sure that people can access care. She questioned that patients would not be able to find a local, in-network provider outside of Salem Health to meet their needs.

“I want to be really clear that our network is adequate. We meet all the network adequacy standards, and there are other in-network facilities and providers who are available to treat our members,” she said.

Muday said that any patient with questions about their coverage should call the number on the back of their insurance card.

“That’s going to get them to the right team that knows the specifics about their benefits,” she said, who typically can answer questions immediately or will call back with an answer for more complex questions by the next day.

“If our member feels that they should be covered under continuity of care and their appointment was canceled, please call us for help again,” she said.

That’s one more point Salem Health agreed on.

“I don’t like to call my insurance company. Nobody likes to call their insurance company, but they really need to reach out to their insurance company and say ‘Where should I be going for care?’” Parr said.

Contact reporter Abbey McDonald: [email protected] or 503-575-1251.

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