POST FALLS (Idaho Capital Sun) — A major Idaho health insurer this week asked the Idaho Department of Insurance to investigate the billing practices of a new North Idaho hospital.
Blue Cross of Idaho claims that Post Falls ER & Hospital has refused offers to be part of the insurer’s network of in-network providers, and has instead relied heavily on a last-resort financial protection that lets health care providers dispute insurer payments.
Blue Cross of Idaho Chief Strategy Officer Drew Hobby said the insurer wants to protect consumers from rising health care costs.
“We have a responsibility to help Idahoans get access to high quality, affordable care. And we’re very concerned and alarmed with this process, which we would say is driving up unreasonable costs and unreasonable rates to Idahoans,” he told the Idaho Capital Sun in an interview.
The Idaho Department of Insurance is reviewing the issue, agency spokesperson Julie Robinson said in a statement.
The Post Falls ER & Hospital opened in 2024. The facility was Nutex Health Inc.’s first micro-hospital in Idaho.
Post Falls ER & Hospital could not be immediately reached for comment.
Outside of the Post Falls ER & Hospital, 100% of hospitals in Idaho are in Blue Cross’s network, Hobby said. Blue Cross also asked the Department of Insurance to help get the hospital’s owners to meet with Blue Cross.
What is the billing practice Blue Cross wants Idaho to investigate?
In its letter to the Idaho Department of Insurance, Blue Cross asked for a probe into whether the Post Falls ER & Hospital has misused a process called independent dispute resolution.
The process, created by the federal No Surprises Act, allows health care providers to challenge denials and payments by health insurers for services that are out of network, triggering arbitration to decide the final payment.
Each week in recent months, Blue Cross received an average of 75 dispute requests from the hospital, the insurer said in its letter. That is much more than the insurer says it received from all other health care entities in Idaho. On average each month, Hobby said Blue Cross only received 14 dispute requests from other providers in Idaho.
“Compared to the rest of providers that we work with … the volume is alarming,” Hobby said.
The payments sought in that process are often high, Blue Cross told the Department of Insurance. One example Hobby shared was a claim for nearly $2,900 to treat a runny nose, which was well over the $376 that is the median commercial rate for nasal congestion.
