High Desert Hoofbeats
December shopping…

Christmas is just days away and last-minute shopping is the order of business for many of us. I need to make a few more purchases for the people on my list, but I find myself having to do some shopping for myself. However, it’s not for anything fun. It’s for health insurance.

Like many other Moab area residents, I get my health insurance through Regence Blue Cross/Blue Shield. For the last dozen years I’ve written a hefty monthly check to them and have been satisfied with their coverage. I have a high deductible so most of my doctor bills are paid right out of my pocket. Forget eye and dental care; I have to pay for all of that.

Regence, one of the largest health insurance companies in the nation, provides coverage to a good percentage of our community. But that could all change if Moab Regional Hospital can’t come to a contractual agreement with Regence. Our community has recently been made aware that MRH won’t honor Regence to the degree it has in the past.

At question is the in-network contract between the hospital and Regence. The hospital is balking at Regence’s proposal to decrease reimbursements by 40 percent. Hospital officials say they can’t afford that size of a cut. Patients who are insured by Regence may be left to pay the balance of their bills that are in dispute between the two entities.

The problem seems to have stemmed from shortly after Allen Memorial moved from its old facility into the new hospital, becoming Moab Regional. The contract between Regence and MRH was in place and was based on costs relative to the old facility. Regence officials claim the new charges from MRH’s new costs were unsustainable, so when the contract was up earlier this year they proposed a fixed-fee payment schedule relative to the diagnosis of a patient. MRH has responded that the hospital would lose $2.6 million per year under the newly proposed payment plan, and asked for a higher reimbursement under the old method, which pays a percentage of the actual cost of procedures.

Did these claims go up to cover the costs of doing business in a new facility, or to help pay for the new facility? Regence claims that our new hospital is the fourth-most expensive hospital in Utah for people insured by Regence. MRH officials say that isn’t the case, and that Regence reimburses them at much lower rates than other insurance providers that the hospital bills. Hospital officials claim that it costs about 44 percent less for patients to have procedures done here than at other hospitals around the state.

I was pleased to learn recently that our new hospital is getting high marks on the national scale and that it has been named one of the top 100 critical access hospitals in America. Quality and expense is relative, as is the cost of doing business in a rural area. It is unclear whether MRH patients will have any financial protection from the Utah Rural Health Care Act, which is designed to prevent rural hospitals from charging patients for the balance of their bills that health insurance doesn’t cover.

As a financially invested bystander in this clash of costs, and as someone who has had all of my voluntary health care needs taken care of in Moab, save for the 15 years I lived in northern Utah, I am more than dismayed. I’m further annoyed that keeping adequate health care insurance seems to have become more of a headache since Obamacare took effect. My acquaintances whose paychecks are diminishing because the costs of their health insurance benefits are growing would certainly agree.

As the final days of December tick by, more news will unfold about this impasse. The hospital is weighing its budget, Regence is weighing theirs, and I am weighing what I can afford. The longtime local company that I purchase my health insurance through will provide valuable advice as to whether I will stick with Regence and how my benefits might change. As that information develops, I will keep shopping. Unfortunately, I may have to research whether my health care dollars are better spent with another insurance provider or possibly with doctors outside of town. Hopefully, it will make financial sense to keep my medical care here.

ByBy Sena Taylor Hauer