Thousands to treat a runny nose? New Post Falls hospital’s billing practices under scrutiny

The Post Falls ER & Hospital is accused of misleading billing and overcharges. | Kathy Plonka, The Spokesman-Review POST FALLS (The Spokesman-Review) — The largest insurance provider in Idaho announced this week that it is seeking a state investigation into how a new hospital in Post Falls is billing its patients by using an arbitration process that it claims has inflated their medical costs. Blue Cross of Idaho said it has engaged multiple times with officials at Post Falls ER & Hospital, located at 497 S. Beck Road, but that the company refuses to become part of the health care provider network. Post Falls ER & Hospital, which opened in August 2024, is owned by Nutex Health Inc., a for-profit provider based in Houston, Texas. It operates dozens of medical facilities in 13 states, according to its website. The Blue Cross letters notes Nutex’s use of the No Surprise Act, a federal guideline that calls for an arbitration process to settle billing disputes. It also noted that Nutex operates mostly as an “out-of-network provider,” which eliminates the option for patients to get the benefit of negotiated insurance rates. “Nutex actively utilizes the No Surprise Act’s arbitration process with the goal of submitting 60-70% of visits to arbitration, despite its recognition of the ‘significant cost to enter arbitration,’ ” according to the news release. Drew Hobby, chief strategy officer for Blue Cross of Idaho, wrote that seeking payment through the independent resolution process can push costs to exceed 1,000% of Medicare reimbursement rates. In one case, Blue Cross received a claim for treating a runny nose that was billed by the Post Falls hospital at $2,872 when the median commercial rate for that treatment is $376. “Blue Cross of Idaho is driven to ensure our members have access to high-quality, affordable healthcare,” Hobby said in the release. He included a letter sent to Dean Cameron, director of the Idaho Department of Insurance, seeking an investigation into Post Falls ER & Hospital’s billing practices. “We ask that your review include ineligible claims, repeated submissions and claims reflecting excessive charges for low-complexity or routine services,” the letter states. It noted that Blue Cross has received about 2,800 negotiation requests related to patients being treated at the Post Falls facility between April 17 and Oct. 28, and all of those bills seek “payments through the (arbitration) process that often exceed 1000 percent of Medicare rates.” Hobby wrote that the arbitration process should be the last resort employed by a medical provider seeking payment. “That’s why we have made multiple attempts to bring Post Falls ER & Hospital into our network,” Hobby wrote in part. “Recently, Post Falls ER & Hospital has not been replying to any of our offers.” According to the news release, Nutex, the owner of the hospital, reported $479.9 million in revenue in 2024, which was a 93.8% increase over 2023. Of that $479.9 million, about $169 million was attributed to arbitration efforts to recoup medical bills. During a webinar in April, Nutex’s chief financial officer, Jon Bates, said 60 to 70% of the company’s emergency room visits go through the arbitration billing process. “And we’re going to continue to do this until we can get to the point that we are getting our fair and equitable payment down the road,” the news release states. In the same webinar, Bates noted the company’s for-profit status. “And then, the ultimate goal, I mean, as a business we’re a publicly traded company, and our shareholders are the most important piece of what we work towards, is just making sure we have that financial stability long-term, and we believe that right now that using his process is one of our best chances to keep that running as steadily as we’ve seen it through the end of the third quarter, in fourth quarter and finishing out the year of ’24 and ’25,” Bates said on the webinar. Calls to Post Falls ER & Hospital and Nutex Health’s corporate offices were not immediately returned on Friday. As a result of its complaints about Nutex’s billing practices, Blue Cross said it is encouraging its members to go to other health care providers in the area. Blue Cross officials did not immediately return a phone call seeking further comment.The post Thousands to treat a runny nose? New Post Falls hospital’s billing practices under scrutiny appeared first on East Idaho News.
Source: eastidahonews.com