PORTLAND, Oregon — The deadline for Legacy Health and Regence to come to terms on a new insurance reimbursement plan is 10 days away, and without a new agreement, tens of thousands of patients could be forced to find new in-network providers or have the financial burden shift to them at out-of-network costs.
Legacy is a major player in providing healthcare for people in Oregon and southwest Washington. Regence is a major health insurance company, covering 30,000 people who have Legacy primary care doctors, and 100,000 patients who visited a Legacy Facility at some time last year.
The two sides have been trying to come to terms to renew a payment agreement for most of a year, and in the final month before the contract deadline, a "best and final" offer from Regence did not cut it with Legacy.
"The best and final was certainly a surprise to us, particularly three weeks before the contract deadline, we thought we would have more time to continue to work together. We have and we'll always look to find a compromise that's in the best interests of our patients and the broader community,” said Merrin Permut, VP and Chief Human Population Health officer at Legacy Health.
Permut said what Regence offered does not match the reality of the rapidly increasing cost of healthcare, and unless Regence rescinds its best and last offer, there’s nothing to negotiate.
But although it appears formal negotiations are off, Regence said it is talking with Legacy's top leadership, looking for a path forward.
In a written statement, Regence said, "We're holding the line on unreasonable provider reimbursement demands because our members, customers and regulators have asked us to rein in the rising cost of health care. We're acutely aware that these negotiations have real impacts on people's lives."
“If terms can't be met, this absolutely disrupts our lives,” said Renae Stansell, whose 5-month-old son, Jonah, has health issues. He's not breast- or bottle-feeding and is not able to move his feet.
Her Legacy medical team at Randall Children's Hospital is trying to solve the problems, with procedures, including surgeries, to come.
Stansell said she has been developing a relationship and care plan with a pediatrician they love and other Legacy providers. The last thing she wants to do is lose the team because she has Regence coverage.
“It just breaks my heart that we've built these relationships with these doctors, and then, I can no longer work with them because my insurance says I can't. It just doesn't sit right with me at all,” said Stansell.
There is a recent history of Regence being at the brink with a provider and coming to an agreement. Providence Health and Services also asked for payment increases that Regence said it couldn't afford, but in January, on the deadline day, the two came to terms.
Stansell, already having a stressful year, is anxiously hoping for the same here. In the meantime, given the financial challenges even beyond health insurance issues, the Stansell family has started a GoFundMe to help offset additional costs associated with Jonah's care.
“Then, it's time for me to kick it into gear and start trying to find a new doctor that will take on Jonah, restart referrals, which takes so long to see specialists," she said. "It just starts the clock all over, and we've been dealing with this since Jan. 1.”
If the two sides don't reach a deal by the deadline, there are some temporary continuing coverage options possible for at least some plan participants. Both Regence and Legacy Health said they will help patients transition to other care, if needed.