EIRMC to change to out-of-network provider under Blue Cross through Your Health Idaho

Correction 11/16/16: According to HealthCare.gov, insurance companies cannot charge you more for getting emergency room services at an out-of-network hospital. Emergency services are required to be covered as if the person’s plan is in-network.

Blue Cross of Idaho informed KIFI/KIDK that EIRMC emergency services under Blue Cross through Your Health Idaho will still be covered as in-network under the standard benefit plan purchased. Emergency care is covered, what is not covered are doctors through EIRMC.

Blue Cross of Idaho also said the network structure is in place to put each member in good communication with a primary doctor. If their primary doctor in-network refers a doctor out-of-network, the patient will still be covered as if they were in-network, based on their standard benefit plan.

Original Story 11/15/16: Those getting health insurance under Blue Cross — through the state exchange Your Health Idaho — will be seeing changes in 2017. Eastern Idaho Regional Medical Center will be labeled as an out-of-network provider.

If you are under this plan, for example, an emergency visit to the only er in Idaho Falls can cost you way more out of pocket than it would if EIRMC was included in the network.

Blue Cross has created a narrow network which has providers based on where they are located. If you go to a health care provider outside of your plan’s network, you will have to pay out-of-network costs — which costs quite a bit more out of pocket.

EIRMC told KIFI/KIDK that on the health exchange in the gold, silver and bronze levels, every Blue Cross product available in each of those levels has EIRMC as out-of-network.

“EIRMC would say, ‘Know what you’re buying.’ Blue Cross would say, ‘Understand how the network works. Ultimately what’s going to be best is for consumers to sit down with their insurance agent and understand how their plan works. Blue Cross’s policy is still going to be Blue Crosses policy. They will pay what they are going to pay. If you’re out-of-network, benefits apply differently than when you’re paying in-network,” said Joshua Tieken, vice president of operations at The Falls Insurance Center.

EIRMC wants to be sure people are very clear on what they are buying — to be aware of the pros and cons when shopping for health insurance.

KIFI/KIDK sat with an Idaho Falls woman who talked about her son’s coverage. The possibility of having higher out-of-pocket costs in the case of an emergency is what caused the her son to change health insurance plans.

“He’s happy. He’s saving hundred’s of dollars a month on insurance. And he’s going to have better coverage. Way better coverage,” said Ellie Hampton.

“EIRMC being out-of-network doesn’t mean you can’t go to EIRMC. What it means is, their coverage will be limited to in-network benefits,” Tieken said.

If you are under Blue Cross with Your Health Idaho, for example, an emergency visit to the only ER, ICU, and trauma center in Idaho Falls can cost you way more out of pocket than it would if EIRMC was still included in the network. There may be a situation to where you need the health care EIRMC provides, but in that case, you’ll have to pay the out-of-network costs yourself.

“Probably 90 percent of the chance you’re going to be taken to EIRMC. If you have an ambulance ride, you’re probably going to EIRMC. An ambulance is not going to stop an ask you, ‘Which hospital is in your network?’ They’re going to take you where the best care can be given,” Tieken said.

Another big detail to clarify: This does not affect employer private insurance. If you are employed by a company that has Blue Cross, you are unaffected. People are only affected if they have Blue Cross through Your Health Idaho. People who buy supplemental Medicare are also not affected.

“What it doesn’t cover are the people who just go online and sign up,” Hampton said.

If you don’t do anything by Dec. 15, those already under Blue Cross through Your Health Idaho for 2016, will be automatically renewed for 2017. Change your plan or notify Blue Cross that you want to change before Dec. 15 to get around that auto-renewal.