Salem Health and Regence have returned to the negotiation table two weeks after their stalemate caused thousands in Salem to lose access to in-network health care at Salem’s only hospital. The split means that some Regence members have spent the first weeks of the year switching insurance, struggling to find alternative providers and even considering moving away from Salem over transportation concerns. Throughout over a year of negotiations, the two parties butted heads over how much the insurance company would pay Salem Health to care for patients. That ended with Regence saying on New Year’s Eve that the health system would no longer be in network for its customers as of Jan. 1. Negotiations resumed Jan. 14, both parties said. Without the contract, Regence patients will pay more out-of-pocket for care at Salem Health, which is now out of network. In addition to operating Salem’s only hospital, Salem Health operates West Valley Hospital in Dallas, urgent care centers in Salem and Woodburn, eight primary care clinics, a lab and other specialty medical offices. The health system is a nonprofit, governed by a board of directors in Salem. After Salem Reporter’s Dec. 31 article about the contract failure, we asked readers to share their perspectives and questions about the separation process of the hospital and insurance company. Dozens responded. One thing was clear among the responses: the separation was more than an inconvenience.Many people had questions, too, like what types of coverage, including emergencies and long term care remain in-network.Glen Kaye and his wife have been using Salem Health since 1997. As a retired federal employee from the National Parks Service, Kaye is part of the Blue Cross Federal Employees Program. He thinks they’re good benefits worth keeping, and his mother was part of the same program and had about a million dollars of cancer treatment fully funded.“This was one of the best insurance coverages out there. It wasn’t cheap,” he said. Kaye said they pay about $10,000 a year in premiums, plus $4,200 to Medicare and $1,260 for dental.  Now in their eighties, Glen is the only driver in their household. When he can no longer drive, he worries about the cost of repeated Uber or Lyft rides out to Stayton, Sublimity or Portland for frequent medical appointments. “If there was something that happened to me, then transportation becomes a critical problem,” he said. “We are vulnerable to anything that might arise for me. Down the road, it’ll happen. We’re just waiting for a bad shoe to drop.”It might mean they’ll have to leave their longtime home of Salem and move to Portland or Eugene. But he worries a similar situation could happen at a hospital in a new city.“One of the observations I’d make to Salem Health is that this population of people covered by federal Blue Cross would be among the best clients to have in terms of getting income,” he said. “I think it could be a stunning mistake to throw them out completely.” He said he lost sympathy for Salem Health’s argument of rising costs when he learned the CEO, Cheryl Wolfe, has a salary of nearly $1.6 million a year. Other respondents said they felt Regence was to blame, pointing to the insurance company’s pattern of contract disputes, including last year’s with Legacy Health and Providence hospitals. “Regence Blue Cross has pulled this crap many times in the past at contract time not caring about their insured. All other insurers work with Salem Health at contract time. Only Regence Blue Cross refuses,” one respondent wrote.Another recalled similar concerns the last time Salem Health and Regence disputes made headlines in 2019. The majority of respondents noted Salem Health’s wide portfolio, some calling it a “monopoly,” and noting recent absorptions of several physician groups including the former Hope Orthopedics clinic and Willamette Urology.Some said they’d spent days trying to find a new primary care provider outside Salem Health accepting new patients, to no avail.“There’s already a shortage of providers,” said Gretchen Chamblin, a Salem resident and Regence member. “It used to be that you could call the doctor and you go in that day, maybe the next day. Now we’re looking weeks and weeks out.” Emergency care remains in-network Chamblin said the most disturbing part of the contract failure, to her, is that Salem Health operates the only emergency department in the city. Federal laws require that patients are charged in-network prices for visits to the emergency department.  “Any costs resulting from visiting the emergency department, a resulting emergency hospitalization or Labor & Delivery will be treated as in-network,” said Salem Health spokeswoman Lisa Wood in an email to Salem Reporter.According to federal guidelines under the No Surprises Act, patients can’t be charged higher than their in-network costs for emergency treatment by the hospital, providers or for an air ambulance. That includes all necessary hospital treatments during the stay.Under federal law, stabilizing services after the emergency are covered, too. But once someone is able to travel to an in-network provider offering needed “post-stabilization” services, they could be charged out-of-network rates if they choose to stay at the out-of-network hospital.The hospital is required to have patients sign a form before such charges incur, and can only give that form to people in a condition to give informed consent, with an interpreter if needed.“Every member who is covered under Regence, in case of an emergency, they should always go to the nearest hospital,” said Zak Ramadan-Jradi, Regence’s vice president of network management in an interview. “Emergency care, including hospital stays that happen as a result of the emergency is covered in-network.”Visiting the emergency room while in labor, and delivering a baby would also be considered in-network, he said. Chamblin shared a Dec. 3 letter her household got from Regence, which she said made the state of emergency coverage unclear.The Regence letter read: “In an emergency, you should always seek care at the closest hospital. Care for an emergency medical condition will be covered as in-network (even if you don’t otherwise have out-of-network benefits), though your out-of-pocket costs will vary depending on your health plan benefits.” Because of the uncertainty, she said her daughter was planning to take her infant out to the emergency room at Samaritan Albany General Hospital if the baby’s dangerous holiday fever returned. “If they are saying that it doesn’t matter if it is in-network or out-of-network for emergency service, they really need to change the language in the letter,” Chamblin said. “Because that’s not how it reads at all.” What else is in-network Salem Health is pausing its collections of co-pays from Regence patients and is holding statements, Wood said.  Under federal law, several categories of patients qualify for continuity of care, meaning they can’t see increased out-of-network prices in the middle of treatment because of the contract failure. Those groups include pregnant patients, patients getting specialized care over a long period of time like radiation therapy, and scheduled non-elective surgeries.Roughly a few thousand people qualify in Salem, Ramadan-Jradi said. Salem Health is asking Regence to extend that to all patient categories, so anyone can keep their established providers in-network. “We have asked Regence to grant continuity of care so all Regence patients can see their providers and receive care at Salem Hospital and West Valley Hospital. We are building workflows in good faith that Regence will return to the negotiating table and agree to a new contract,” Wood said. There is no deadline to reach an agreement, but they hope to reach one as soon as possible, Wood said.  In a Jan. 9 press release ahead of the negotiations continuing, Salem Health reiterated its longstanding position that Regence was underpaying for health coverage. During earlier negotiations, Salem Health sought a 35% increase in the amount they bill Regence.“Regence has been unwilling to agree to a contract that reflects the costs of providing care in 2025. Salem Health successfully negotiated 2025 contracts with 14 other insurers who recognize that local nurses, doctors and support staff need to be fairly compensated to maintain access for patients. Only one insurer has been unwilling to agree to market-based terms,” the release said.  Ramadan-Jradi reiterated Regence’s longstanding position, that Salem Health was asking too much. “We really ask Salem to be realistic and be aligned with the Oregon Cost Target,” a 3.4% increase, he said. “Secondarily, we need to do what’s important for our community, for our members.” Contact reporter Abbey McDonald: [email protected] or 503-575-1251. A MOMENT MORE, PLEASE– If you found this story useful, consider subscribing to Salem Reporter if you don’t already. 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