Contract dispute means bigger PMC ER bills for many — at least for now

POCATELLO — The emergency room physicians at Portneuf Medical Center recently formed their own practice, prompting a contract negotiation process between them and two major Idaho insurance companies that has left many ER patients with larger than normal medical bills.


However, there is hope for Blue Cross of Idaho and Regence BlueShield of Idaho patients because officials negotiating the contract on behalf of the new ER practice, named Rocky Mountain Physician Group, or RMPG, are optimistic that once signed by all sides the contracts will include a retroactive clause, which would reimburse the patients for the out-of-network charges that are driving up their bills.


When asked if PMC ER patients would be reimbursed for these out-of-network charges incurred prior to the new contracts being signed, Bill Carns, the chief operating officer of the Arizona-based PracticeMax — the administrative agent for RMPG — said, “Yes, that is the hope and desire.”


Carns added, “It’s dependent upon the contract and whether the insurance companies are amenable to something like that. In some cases, an insurance company will agree to that but as far as (RMPG) is concerned, they are certainly amenable to that.”

Carns said that if a PMC ER patient insured by Blue Cross of Idaho or Regence BlueShield of Idaho had paid a bill for an ER visit at the hospital and new contracts with the insurance companies are made retroactive then the patient would be entitled to the difference and RMPG would refund the patient.


Currently, all portions of an emergency room visit at PMC are covered for people insured by Blue Cross of Idaho or Regence BlueShield of Idaho, including any X-rays and lab work with the exception being the actual work or portion of the visit involving an emergency room physician — all of whom are now part of the newly formed RMPG.

Carns told the Journal that RMPG has successfully negotiated contracts with several other insurance companies but discussions remain ongoing with Blue Cross of Idaho and Regence BlueShield of Idaho.


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