St. Luke’s joins the health insurance business. Can it become a monopoly? [The Idaho Statesman] – InsuranceNewsNet

Saint Luke’s Health System, the largest health care system in Idahostarted its own health insurance plans.

The nonprofit subsidiary, called St. Luke’s Health Plan, will provide new coverage options to residents in the west central and south central regions of the state. Enrollment begins in mid-October, with plans taking effect in January.

While the new plans won’t change who can receive care at St. Luke’s facilities, the move will put the company in control of both delivery and payment for many of its health care services.

So you might be wondering: Can St. Does Luke use his health insurance plans to refer patients to his own hospitals and clinics? And as a result have an unfair advantage over other providers?

When St. Luke announced his decision to enter the health insurance business in August, we asked Idaho Department of Insurance Director Dean Cameron what was he thinking He said yes, St. Luke’s Health Plan certainly can and likely will refer patients to providers in the health system’s network. But he said it was no problem.

“We believe we have all the safeguards in place to make sure this does not become a monopoly agreement or an abuse of power,” Cameron told the Statesman by phone. “They had to provide us with documentation to show that users would be treated reasonably if they went off-grid.”

A spokesman for the main competitor of St. Luke, Saint Alphonsus Health System in Boycedeclined comment.

Cameron said Idaho is fortunate to have eight carriers offering health insurance plans including Blue Cross of Idaho Health Services Inc., Molina Healthcare of IdahoMountain Health Co-Op, PacificSource Health Plans, Regence BlueShield of Idaho Inc., SelectHealth Inc. and UnitedHealthcare.

In addition, the state’s health insurance carriers are already working with providers to develop competitive contracts.

“Other states are lucky to have one or two health plans,” Cameron said. “Our insurance carriers work with providers of all kinds to develop the most competitive contracts, and we want them to do that, because then that gives us as consumers a lower price.”

He said that St. Luke’s has agreed that it will charge all health insurance carriers the same rate for any particular medical service, even though there is nothing in the law that requires it.

Cameron said the health system has been transparent and cooperative through every step of the process, but he will monitor compliance with market standards and fair trade practices.

“They want to be very accommodating with us,” he said. “So I’d be surprised if they try to change that.”

The health system, which has hospitals and clinics throughout the state, filed its notice of intent to offer health insurance in March with the state Department of Health Insurance. The initial coverage area will include Hell, Adams, Blaine, Boyce, Camas, Canyon, Cassia, Custer, Elmore, precious stone, GoodingJerome Lemhi, Lincoln, Minidoc, Owyhee, Payet, Twin Falls, Valley and Washington counties.

Matt Wolffpresident of the company’s health plan, believes that combining health services and insurance will make an already complex process more seamless.

“St. Luke’s Health Plan will connect the delivery of care with the financing of care, resulting in a more streamlined and cost-effective health insurance option for our communities,” Wolff said in a news release.

The hospitals and clinics of St. Luke’s will continue to accept most other health insurance plans, according to the release.

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