Eliminating a loophole that can leave patients owing tens of thousands of dollars, even when they use a hospital in their insurance network, is a priority of the top executive of Regence BlueShield of Idaho.

The insurance provider’s president, Sean Robbins, 40, said Regence plans to introduce a bill in the coming Idaho legislative session to end surprise medical billing.

He talked about the idea when he visited Lewiston on Thursday, about one year after being promoted to his present position.

He moved to Idaho from Oregon, where he was a senior vice president of public affairs and policy for Cambia Health Solutions, which is affiliated with Regence BlueShield of Idaho.

Robbins’ plan to address surprise medical billing stems from a philosophy he developed in his former position of taking a proactive approach to problems.

Surprise medical billing occurs when physicians aren’t in the insurance networks of the hospitals where they practice and charge more than what patients’ insurance covers for services.

In those instances, patients are responsible for the difference, which in extreme cases can be as much as $40,000, Robbins said.

Regence BlueShield of Idaho’s proposal would require all physicians to accept the rates for in-network doctors as full payment when they are treating patients at hospitals within patients’ insurance networks, especially in emergency situations.

“We think it’s a fair and simple approach,” he said.

Pushing for an end to surprise medical billing is just one of the ways Regence BlueShield of Idaho is trying to control medical care costs.

The insurance provider is affiliated with Cambia Health Solutions in Oregon, the parent company of Regence BlueShield in Washington, Regence BlueCross BlueShield of Oregon and Regence BlueCross BlueShield of Utah.

Cambia Health Solutions has been considering combining with Blue Cross and Blue Shield of North Carolina.

Part of the appeal of the deal is that Blue Cross and Blue Shield of North Carolina has led the nation in value-based approaches to health care, which seek to lower costs and improve outcomes, Robbins said.

That deal, however, is on hold for now after the resignation of Patrick Conway. He had served as the CEO of Blue Cross and Blue Shield of North Carolina and was expected to lead the organization after the partnership was finalized, Robbins said.

Several media outlets have reported Conway faces charges of driving while impaired and misdemeanor child abuse. The charges stem from a traffic accident where Conway was allegedly driving with his children in June, according to the news organizations.

“The affiliation may move forward ... but it may be under different leadership,” Robbins said. “It’s too early to tell.”

What Blue Cross and Blue Shield of North Carolina has been doing to improve medical care is similar to efforts under way at Regence BlueShield of Idaho, he said.

The Idaho insurance provider is looking for ways to reward physicians who improve patient outcomes efficiently. That’s different than a traditional model where physician compensation is based on exams and medical tests that are billed to patients.

The approach includes increased communication between primary care physicians and the specialists they refer their patients to, as well as follow-up calls to patients to be sure they are taking medications.

Regence BlueShield of Idaho has also given its employees greater latitude to help customers by encouraging them to provide what previously would have been considered extra services.

Employees now might coordinate transportation for elderly patients to doctors’ appointments or help customers realize they are facing mental health issues and arrange counseling.

“We have a vested interest in helping (patients) with the outcome and they have an expectation of us that we’re helping control the cost,” he said.

Williams may be contacted at ewilliam@lmtribune.com or (208) 848-2261.