Regence BlueShield Contract with Kootenai Health

Despite the hospital’s good faith efforts, Kootenai and Regence BlueShield were unable to agree upon mutually acceptable contract terms and rates that are sustainable for Kootenai Health. Kootenai remains committed to providing high-quality health care services to its community and continues to contract with many other major health plans in the area.

An established patient is someone who:

• Was actively receiving care at Kootenai Health prior to January 1, 2026, and
• Has medically necessary services ordered before that date.

No, out-of-state Regence is NOT impacted. Only Regence of Idaho plans are impacted, including Federal Regence Blue plans (such as Federal Employee Program plans).

Patients who establish care on or after January 1, 2026 may be subject to out-of-network rates until contract negotiations with Regence of Idaho are resolved.

If you are an established patient and:

• Your surgical or medically necessary service was ordered prior to January 1, 2026, AND
• Your service is scheduled to occur after January 1, 2026, but before March 31, 2026.

Your care will be covered under continuity of care provisions and processed as in-network.

Yes. Kootenai Health remains committed to caring for our community and will continue to provide medically necessary care.

Continuity of care allows established patients to continue receiving medically necessary services at in-network rates for a limited period, even during contract negotiations.

It is Regence BlueShield’s responsibility to notify its enrollees that this termination has occurred. If you have any questions for Regence BlueShield, they can be contacted at (888) 367-2117.

If a new agreement is not reached by January 1, 2026, Kootenai Health may be considered out-of-network for Regence members.

That means Regence BlueShield of Idaho will consider Kootenai an “out-of-network” provider. As a result, you may face higher co-payments, co-insurance payments, and other out-of-pocket costs if you continue to rely on Kootenai for your health care. You should check with Regence BlueShield for coverage determination.

For emergency services, you can continue to receive care at Kootenai Health. If you are in the middle of a course of treatment or have a surgery or procedure scheduled, you may be able to continue to have that care at Kootenai. In some instances, Regence may cover elective or non-emergency services at Kootenai. Contact Regence to determine whether Regence will authorize your care at Kootenai and what your out-of-pocket costs will be. If an agreement between Kootenai Health and Regence BlueShield occurs after January 1, 2026, Regence will reprocess any claims made in 2026 and reimburse patients as contracted.

Many key services will be affected, including but not limited to:

• Any care received at Kootenai Health, including all inpatient and outpatient surgeries and services except for emergency care
• Outpatient therapy with Kootenai Health Rehabilitation Services
• Endoscopy procedures with Kootenai Clinic Gastroenterology and Endoscopy
• Infusion services such as chemotherapy
• Imaging studies, including those provided at Kootenai Heart Clinics and Kootenai Outpatient Imaging

Yes. If you see a Kootenai Clinic provider before January 1, 2026, your visit will be considered in-network. Beginning January 1, 2026, if a new contract agreement has not been reached, your visits will be considered out-of-network. Additionally, beginning January 1, 2026, some services provided at Kootenai Clinic offices, such as imaging studies, may be considered out-of-network.

No. Kootenai Urgent Care operates three facilities in Idaho, which are separate from Kootenai Health. These urgent care facilities have separate contracts with Regence BlueShield of Idaho that remain in force and in effect.

Most Regence BlueShield plans are affected by this termination. This includes:

• Asuris
• BridgeSpan
• Healthcare Management Administrators (HMA)
• Regence Group Administrators
• Regence Medicare Advantage
• Uniform Medical Plan (UMP)
• Any Regence BlueShield of Idaho Commercial Insurance Plan

Regence Medigap and Regence Medicare Supplement plans are not impacted by these negotiations. Medigap and Medicare Supplement plans are not contracted plans; they are considered in-network when Traditional Medicare is in-network, regardless of the private insurers contracted status.

Talk to your employer or insurance broker about your health insurance options. Your employer or insurance broker may be able to help you and allow you to switch to another insurance provider that covers the services offered at Kootenai. We are proud of our commitment to accept nearly every insurance plan serving this area. While we may be unable to accept Regence BlueShield insurance in the future, we welcome many other leading health plans.

You may be. You should check with Regence to find out if your insurance will be affected once Kootenai goes out-of-network with Regence.

If an agreement is not finalized by the end of the year, negotiations will continue until a resolution is reached. In the meantime, certain patients, including expectant mothers, cancer patients currently undergoing treatment, and others with qualifying conditions, may still have coverage under a federal 90-day continuity of care provision. This means you can continue receiving care at Kootenai Health even if we are temporarily considered out-of-network.

Please note: Patients who may qualify must contact Regence for authorization. Please use the customer service number on the back of your insurance card.
We understand how important uninterrupted care is for you and your family. Please know that both Kootenai Health and Regence are committed to finding a solution as quickly as possible.

For questions about your coverage or eligibility under continuity of care, please contact:

Regence Customer Service: 1-888-675-6570
Kootenai Health Hotline: (208) 625-6228

In an emergency, you should seek care at the closest facility that can provide that care. As a non-profit hospital, Kootenai Health is committed to providing care in an emergency situation, regardless of the patient’s ability to pay.

We worked hard to reach an agreement with Regence, but their requirements were outside what we could accept in good conscience. In the end, we determined that accepting contract terms with rates below market value is risky, unsustainable for Kootenai Health, and would not be a responsible choice for our hospital.

Yes, updates may occur as negotiations continue. We encourage patients to check this page regularly for the most current information.