Salem Health remains in Regence network through year end but negotiations have stalled

As negotiations continue, we want to make sure our members are prepared if Salem Health leaves our network at the end of the year.

Regence members may continue to access Salem Health providers and facilities at in-network rates through Dec. 31, 2024.   

We maintain a strong network of hospitals, facilities and primary and specialty providers in Oregon. Regence members may find in-network providers by signing in at regence.com and selecting Find Care, using the Regence app, or calling customer service at the number on the back of their member ID card.

Members undergoing current treatment may qualify for what’s called “Continuity of Care,” and are urged to call customer service at the number on the back of their member ID card. 

Do I qualify for Continuity of Care (CoC)? 

To qualify, members need to be undergoing a course of treatment or scheduled to undergo nonelective surgery with Salem Health. Examples of conditions that may be considered include but are not limited to: 

• Inpatient admissions, including acute hospital and behavioral health levels of care 
• Transplant 
• Pregnancy in the second or third trimester 
• High-risk pregnancy, in any trimester 
• Cancer treatments 
• Trauma 
• Behavioral Health diagnoses with regular visits with specialist providers
• Terminal illness 

How long does CoC last? 

For non-pregnancy related conditions, the CoC clock starts when the member is notified of a termination by letter or phone and will last for either 120 days, or the day after a final course of treatment is completed if that’s sooner than 120 days. For pregnancy-related care, CoC will end either on the 45^th day after birth, or 120 days after the member is notified of a termination, whichever comes first. 

For Medicare Advantage members, CoC lasts for 90 days after the date of termination, March 31, 2025, in the case of Salem Health.   

Again, Regence members should call the number on the back of their member ID card if they believe they may qualify for CoC.

What if I’m experiencing an emergency?

Members may receive emergency care, including being in active labor, at in-network rates at any hospital regardless of network because of the federal No Surprises Act. Out-of-pocket costs will vary depending on your health plan benefits. The Act protects members from surprise bills for most emergency services, even if they were received from out-of-network providers and without prior authorization. 

Previous update from Oct. 25, 2024

Despite weeks of discussion, the leaders of Salem Health have held firm on their demand for what we estimate to be a 35% increase in what they get paid to provide care to Regence patients in 2025, and an additional 15% in 2026.

A 35% increase in what we pay Salem Health for care would:

• Increase an emergency room visit by more than $1,000
• Increase the cost of a c-section by about $7,600 and
• Result in an estimated increase in the cost of a knee replacement by a whopping $17,600

We are disappointed that Salem Health’s leadership has chosen this path, which now requires us to formally notify Regence members who have used Salem Health in the past year that the provider will likely be leaving our network on Jan. 1, 2025.

We have tried several times to engage Salem Health’s leadership to support our members who are in an active course of treatment to transition their care to other in-network providers, but they have refused to work with us to support these members. If Salem Health leaves our network, members currently receiving care from Salem Health providers may have the right to continue in-network treatment for a limited time after Jan. 1, 2025. Eligible conditions include but are not limited to:

• Seeing the provider for a serious or complex condition, including certain chronic conditions
• Undergoing a course of institutional or inpatient care from the provider
• Being scheduled for nonelective surgery from the provider
• Being pregnant and seeing the provider for pregnancy-related care
• Being determined to be terminally ill

Members who may be eligible for continuing care are urged to call us at the number on the back of their member ID card. For members who are receiving care from Salem Health and would like to explore their options to move their care to another in-network provider, please call us. We’re here to help.

Below is a short list of alternative providers. For a complete list, please sign in at regence.com and select Find Care. Or call us for help finding an in-network provider near you.

We will update this article as negotiations unfold.

Previous update from Oct. 4, 2024

Salem Health’s leadership made the unnecessary decision to issue early public notice regarding our contract negotiations, even though our contract extends another three months through Dec. 31, 2024.

Regence members may continue to access Salem Health providers and facilities at in-network rates through Dec. 31, 2024.

Between 30-45 days before a contract ends, insurers are required to notify members of a possible termination. Contract negotiations between insurers and provider systems happen all the time and most resolve before public notice is required. This saves needless concern for the people we jointly serve.

The recent announcement by Salem Health’s leadership well before any required public notice unnecessarily alarms Oregonians. This is a tactic some provider systems use to influence public opinion and pressure insurers to agree to unreasonable rate increases.

In this case – based on our calculations – Salem Health is demanding an increase of an estimated 35% in what they get paid for care. Considering the state’s 3.4% Cost Growth Target and the economic forecast of a less than 3% income increase for Oregonians in the coming years, this demand is both unconscionable and outrageous. This demand is down from the initial estimated 41% demand for increases in treatment costs.

We negotiate the cost of care on behalf of our members and employer groups to maintain access to high-quality, affordable care. As a tax-paying nonprofit, our premiums and out-of-pocket costs for medical care directly reflect what providers charge. Our members and employer groups simply cannot afford a 35% increase in what they pay to access care at Salem Health, nor should they have to.

We await further discussions from Salem Health as we attempt to negotiate in good faith, but they have not signaled a willingness to do so.

It is true that Salem Health’s doctors and facilities are important to our network and our members, but we also maintain a strong network in Oregon with ample access. This includes Oregon Health & Science University, Legacy Health, Silverton Memorial Hospital, Samaritan Albany General, Santiam Hospital, the Salem Clinic, South Salem Primary Care, Willamette Family Medical Center, Silver Creek Family Medicine, West Salem Family Medicine, Primary Care West, Family Medicine LLC, and hundreds of other primary and specialty providers.

We will continue to update this article as conditions change. If you are a Regence member and have any questions or need help finding a new provider, please call us at the number on the back of your member ID card. We’re here to help.