Contract dispute between PMC and Regence insurance could raise members’ health care costs

POCATELLO — Many southeast Idahoans are on the brink of losing Portneuf Medical Center as an in-network health care option as the hospital and one of the area’s largest insurance providers struggle to reach an agreement on costs.

Regence BlueShield of Idaho recently announced that it is in negotiations with Portneuf Medical Center, a Pocatello hospital owned by both Ardent Health Services and the Portneuf Health Trust.

According to a news release from Regence, “The leaders of Portneuf Medical Center have informed us that they wish to end their contract with Regence for commercial and individual plan members on June 15, 2026.”

The release states that this would impact Portneuf Medical Center, Pocatello Health Services, PHS Ambulatory Services and Portneuf Ambulatory Surgical Center.

“Portneuf Medical Center’s owner and operator – Tennessee-based, for-profit Ardent Health — is asking for double-digit increases in reimbursement rates, more than twice the rate of inflation,” Regence says.

“As your local, nonprofit health plan, our premiums directly reflect the prices provider systems charge for health care,” the release continues. “While we are open to negotiating increases, we cannot accept the rates currently being demanded by Ardent Health’s executives.”

Regence says it is trying to keep its members from paying more for healthcare by refusing to agree to an increase in what it pays Portneuf to provide care.

“Regence has provided Idahoans access to high-quality health care for 80 years. We invest 87 cents of every premium dollar directly into our members’ health care,” Regence says. “So when providers demand more money, local businesses and health plan members will pay more for their health care.”

On the other hand, a news release from Portneuf claims it is asking for the increases due to issues with Regence.

“Regence currently reimburses Portneuf substantially less than other major insurers in our market, and less than it pays many other Idaho health systems,” the Portneuf release states. “In addition to reimbursement concerns, we continue to experience challenges related to unpaid claims, denials and reprocessing requirements from Regence. These issues increase administrative burden and can unnecessarily delay patient care.”

If the two companies cannot come to an agreement by June 15, many Portneuf facilities and employed providers would be out of network for Regence members. That means those patients may face higher out-of-pocket costs for non-emergency care after the out-of-network dates.

“We are seeking a fair agreement that helps narrow this gap and supports the long‑term sustainability of care in our community,” Portneuf says in its release.

According to Portneuf, emergency care will not be impacted, as required by law, even if Portneuf becomes out-of-network with Regence.

Additionally, some patients may qualify for continued network coverage from Portneuf facilities if they meet the following criteria:

• Seeing the provider for a serious or complex condition, including certain chronic conditions.
• Undergoing a course of institutional or inpatient care from the provider.
• Scheduled for non-elective surgery from the provider.
• Pregnant and seeing the provider for pregnancy-related care.
• Determined to be terminally ill.

If you have Regence BlueShield of Idaho and would like to know more about other in-network plans and providers, click here.

You can also see more in-network providers that accept Regence BlueShield of Idaho insurance by clicking here.

CORRECTION: An earlier version of this story’s headline incorrectly stated that Regence members would lose insurance coverage, rather than simply losing Portneauf Medical Center as an in-network option.

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