St. Luke’s is joining the health insurance business. Can it become a monopoly? [The Idaho Statesman] – Insurance Newsnet

Saint Luke’s Health System, the largest health care system IdahoStarting their own health insurance plans.

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

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

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

When St. Luke’s announced its decision to enter the health insurance business in August, we asked Idaho Department of Insurance Director Dean Cameron What did he think? He said yes, St. Luke’s Health Plan will definitely, and likely, refer patients to providers within the health system’s network. But he said it was not a matter of concern.

“We believe we have all the safeguards in place to ensure that this does not become a monopolistic arrangement or an abuse of power,” Cameron told the Statesman by phone. “They had to provide us with documentation to show that consumers would be treated fairly if they went out of network.”

A spokesman for St Luke’s main competitor, St. Alphonsus Health System in Boisedeclined to comment.

Cameron said Idaho It is fortunate to offer eight carriers with health insurance plans Blue Cross of Idaho Healthcare Inc., Molina Healthcare of IdahoMountain Health Co-op, PacificSource Health Plans, Regence BlueShield of Idaho Inc., Select Health Inc. and United Healthcare.

Also, health insurance carriers in the state are already working with providers to develop competitive contracts.

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

He said St. Luke’s agreed to charge all health insurers the same rate for a particular medical service, even though there is nothing in the law that requires it to do so.

Cameron said the health system has been transparent and supportive at every step of the process, but he is looking to ensure market standards and fair-trade practices are met.

“They want to be more consistent with us,” he said. “So I’d be surprised if they tried to change it.”

The health system, which has hospitals and clinics around the state, filed a notice of intent to offer health insurance with the state Department of Health Insurance in March. The initial coverage area will include Ada, Adams, Blaine, Boise, Kamas, the valley, Cassia, Custer, Elmore, gem, GoodingJerome Lemhy, Lincoln, Minidoka, Owyhee, Payette, Twin Falls, Valley and Washington Counties.

Matt WolfePresident of the company’s health plans, he believes that the combination of healthcare and insurance will make the already complex process even easier.

“St. Luke’s Health Plan will connect the delivery of care with the funding of care, resulting in a simpler and cost-conscious health insurance option for our communities,” Wolfe said in a news release.

St. Luke’s Hospitals and Clinics will continue to accept most other health insurance plans, according to the release.

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