Dean Cameron, director of the Idaho Department of Insurance, advised state lawmakers to launch an extended examination of the health insurance sector before the 2027 legislative session begins. The recommendation was made to the Legislature’s Health Insurers Working Group, which is tasked with identifying systemic issues affecting consumers and businesses across Idaho.
Cameron, a former legislator with 25 years of service in Boise, suggested reviving previous oversight methods used during summer task force meetings. “It might be time to consider dusting that process off,” Cameron said regarding the need for deeper analysis of market stability.
Regence Complaints and Provider Disputes
A major focus of the working group’s attention is Regence BlueShield of Idaho, which recently assumed the contract for state employee health coverage. Data shows a rise in complaints against the insurer that were resolved by external reviewers starting in 2024. In 2025, Regence faced 217 such complaints, with external arbitrators overturning just under a third of the initial decisions. Typical grievances involve denied claims, pharmacy benefit issues, and plan cancellations.
The working group was originally formed after contract negotiations collapsed between Regence and Portneuf Medical Center in Pocatello. The two parties reached an agreement last month to restore their network relationship. Nate Carter, CEO of Portneuf Medical Center, addressed the committee on Tuesday to discuss the resolution.
PBM Fines and School Trust Crisis
The Department of Insurance has also enforced new regulations on pharmacy benefit managers (PBMs). Following a 2024 legislative bill targeting these middlemen, the department has issued nearly $400,000 in fines. Additionally, the state prohibited coverage for prescription weight-loss medications in late 2025.
Financial concerns extend to public education funds. In late August, the Department of Insurance petitioned a state court to assume control of the Idaho School Benefit Trust, which appears unable to cover health insurance claims for public school employees. The department is investigating the trust’s financial decline and expects findings within the next couple of months.
Reimbursement Delays in North Idaho
Payment delays remain a significant issue for providers in Kootenai County. Blue Cross has designated Post Falls ER and Hospital as out-of-network, forcing the facility to rely heavily on Independent Dispute Resolution arbitration. Sen. Kevin Cook (R-Idaho Falls), who oversees the state’s shift to privatized Medicaid, questioned the necessity of meeting outside the legislative session but emphasized the urgency of payment issues.
“I don’t see any reason why a provider should be calling a legislator and saying ‘I’m not getting paid,’ or ‘My reimbursement is nine months late,'” Cook said. He previously sponsored legislation to restore Medicaid mental health benefits that had been cut by a contractor.