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.

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 you are in the midst of treatment at a Kootenai facility, you are entitled to completion of that treatment, and Regence is obligated to continue to reimburse Kootenai for that treatment under the terms of our prior contract, until your care can be safely discontinued. You should call Regence directly at (888) 367-2117 to understand your options.

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.