Regence Health Insurance Review, Pros and Cons, Coverage, How to Apply

Regence Health Insurance is a major health insurance provider operating in the Pacific Northwest, offering plans in Oregon, Washington, Utah, and Idaho. With over 90 years of experience in the insurance industry, Regence has established itself as a leading carrier in these states.

This article provides an in-depth look at Regence Health Insurance, including its pros and cons, plan options and coverage details, how to apply for plans, customer satisfaction and reviews, alternatives, and more. Whether you are considering Regence for your health insurance needs or are just looking to learn more about this major carrier, this comprehensive guide covers everything you need to know.

About Regence Health Insurance

Regence Health Insurance is part of the Regence Group, a not-for-profit health insurance company based in Portland, Oregon. Founded in 1942 as the hospital service division of Blue Cross of Oregon, Regence has grown into one of the largest health insurance providers in the Northwest region over its long history.

Regence offers a wide array of health insurance options including HMO, PPO, EPO and POS plans for individuals, families and employers. It provides coverage for doctor visits, hospital care, prescriptions, mental health services and more. Regence has an extensive provider network with access to leading doctors, specialists and hospitals across its states of operation.

As a not-for-profit insurer, Regence reinvests its earnings back into the health care system through programs, partnerships and initiatives aimed at improving overall community health. The company emphasizes preventative care and services that support long-term wellness.

Pros and Cons of Regence Health Insurance

Pros of Regence Health Insurance

• Large provider network: Regence offers access to over 100,000 providers across its four states, including prestigious health systems. This makes it easy to find doctors and get care.
• Range of plan options: Regence has PPO, HMO, POS and EPO plans to fit different needs and budgets. This includes both individual and family plans.
• Preventative care coverage: All Regence plans cover annual physicals, immunizations, cancer screenings and other preventative services with no out-of-pocket costs. This promotes routine care.
• Member perks: Regence members get access to wellness programs, fitness benefits, discounts and an online member portal with health resources.
• Strong financial ratings: Regence has excellent financial strength ratings from firms like A.M. Best. This indicates its ability to pay out claims.

Cons of Regence Health Insurance

• Limited regional availability: Regence only operates in Oregon, Washington, Utah and Idaho. It’s not an option for those living outside these states.
• No out-of-network coverage: Regence’s HMO plans require using in-network providers only. The PPO out-of-network coverage has higher costs.
• Prior authorization required: Regence requires prior approval for certain services, tests, procedures and prescriptions before they are covered.
• Complaints about claims: Some customers report issues with claims being denied or inaccurately processed by Regence.
• Lack of national presence: Regence lacks the national reach and recognition of top insurers like UnitedHealthcare or Anthem.

Plans and Coverage Offered by Regence Health Insurance

Regence offers a number of different health insurance plans for individuals, families and employers to choose from:

• HMO Plans: With Regence HMO plans, members select a primary care physician (PCP) to coordinate care and provide referrals within the network. Out-of-network care is not covered except in emergencies. HMO plans have lower premiums but restrictive provider choice.
• PPO Plans: The Regence PPO plans allow members flexibility in choosing doctors without referrals. Out-of-network care is covered but with higher out-of-pocket costs. PPO plans have higher premiums but more choice.
• EPO Plans: Regence EPO plans also require using in-network providers only but do not require PCP referrals to see specialists. They offer more flexibility than HMO plans but less than PPO plans.
• POS Plans: With Regence POS plans, members can use out-of-network providers at higher costs. They combine features of HMO and PPO plans.

In addition to doctor visits and hospital services, Regence plans cover prescriptions, mental health services, maternity care, pediatric vision and more. High deductible plans compatible with Health Savings Accounts are also available.

How to Apply for Regence Health Insurance

There are a few ways to apply for and purchase a Regence health insurance plan:

• Through Healthcare.gov: During the open enrollment period each year, you can browse and enroll in Regence health plans on the federal marketplace website. Subsidies may be available for qualifying applicants.
• Directly through Regence: You can apply for individual Regence plans year-round directly through their website or by contacting a sales representative. No subsidies are available, but you get to work directly with Regence.
• Through an insurance agent: Independent health insurance agents can show you available Regence plans and help you apply. Agents offer personalized service and advice.
• As part of an employer plan: Regence coverage may be offered through your workplace as an employee health benefit. Check with your HR department about coverage options.

To apply, you’ll need personal and household information, ID, income details and a list of your prescription medications. This allows Regence to provide an accurate quote. Be sure to carefully compare plans based on premiums, deductibles, provider networks and estimated out-of-pocket costs.

Regence Health Insurance Reviews and Customer Satisfaction

Regence health insurance gets mixed reviews from customers regarding claims processing, customer service and overall value:

• Positive reviews praise Regence’s comprehensive coverage, large provider network and member perks like fitness benefits. Many customers report receiving good care and having claims paid without issue.
• However, negative reviews cite problems with inaccurate or denied claims, surprise bills and delays getting issues resolved by customer service. Some find premiums expensive for the benefits received.
• According to JD Power’s 2020 U.S. Commercial Member Health Plan Satisfaction Study, Regence scored below average compared to other health insurers, ranking particularly low in communication, claims processing and customer service.
• Regence has an average rating of 1.5 out of 5 stars from customers on third-party review sites like ConsumerAffairs and Trustpilot based on complaints about billing, coverage and service issues.
• While opinions are mixed, potential applicants should thoroughly research Regence’s customer ratings in their state before signing up for coverage.

Regence Health Insurance Alternatives

Some alternatives to consider instead of or in addition to Regence include:

• Kaiser Permanente: Available in OR and WA, Kaiser is great if you want integrated medical and insurance from the same provider network.
• Providence Health Plans: Providence offers competitive PPO and HMO plans in OR, WA and ID through its large regional provider network.
• PacificSource: A smaller insurer with HMO and PPO plans available in OR, WA and ID with a focus on holistic wellness.
• Cigna: Known nationally for PPO plans and consumer-driven health plans paired with HSAs. Available in Regence states.
• Aetna: National insurer with PPO and HMO plans offering extensive provider access and health programs through gyms.
• UnitedHealthcare: Top nationwide insurer with many plan options and access to their large UnitedHealthcare provider network.

Whether another insurer is more affordable or offers better coverage depends on your location, health needs and budget. Shop around before deciding.

Conclusion

Regence Health Insurance offers comprehensive medical insurance to residents of the Pacific Northwest through its broad provider network and range of plan options. While it meets many customers’ needs, downsides exist like claims issues, limited availability and mixed reviews. Weigh the pros and cons carefully when considering Regence for your health insurance. Comparing coverage and costs to alternatives like Kaiser Permanente, Cigna or Providence can help find your best option.