OU Health Physicians, Oklahoma Blues strategy fail to reach new contract
< img src="https://covidglobalmap.com/wp-content/uploads/2021/03/D7gsQ0.png"class ="ff-og-image-inserted"> A disagreement over supplier compensation rates will quickly leave more than 830,000 clients out-of-network at Oklahoma’s biggest physician group.
Blue Cross and Blue Guard of Oklahoma and OU Health Physicians were not able to finalize an agreement for 2021. The health system and BCBS of Oklahoma have actually now entered a 120-day shift period, where BCBS of Oklahoma members can still get in-network treatment through June 28. At that point, OU Health Physicians will be considered out-of-network for BCBS of Oklahoma members.
The healthcare system stated it provided services to approximately 131,600 BCBS insured clients in 2020. In a letter to these clients, Dr. John Zubialde, president of OU Health Physicians, stated settlements in between the 2 parties have extended at least a year.
“For years BCBS has underpaid OU Health Physicians, bringing damage to our state by preventing us from effectively buying education, research and medical care,” Zubialde wrote, adding that the insurance company has “unparalleled market share” and tape-recorded “windfall profits” throughout the COVID-19 pandemic.
In addition, the insurance company’s low compensation rates have actually contributed to the state’s physician lack, Zubialde stated, given that OU Health Physicians trains 80% of the doctors in Oklahoma. A 2017 study by the Kaiser Household Foundation discovered that Oklahoma has 85 physicians per 100,000 individuals, compared to a national average of 260 service providers per 100,000 people. If BCBS and OU Health Physicians were not able to reach a contract, the group included that it would require patients to travel hundreds of miles to find in-network specialized care and drive healthcare dollars out of state.
Dr. Todd Hoffman, chief medical officer at BCBS, Hoffman included that the insurance provider helps resolve the state’s doctor shortage by purchasing the state’s Doctor Manpower Training Commission, which helps doctor repay their trainee loans for practicing in rural or underserved areas.
BCBS called OU Health Physicians’ reimbursement request “excessive,” including the group is calling for higher rates while providing no new access to look after its members. OU Health Physicians makes up 1,000 suppliers in BCBS’ 21,000 providers offered in its main PPO network. The dispute will not affect gain access to for patients in Tulsa.
“It’s a big deal for the state and for everybody,” Hoffman said. “What all of it come down to is we’re going to stand by our members. Do we desire OU to be in our network? Definitely. But we have to have a fair deal for our members. They’re the ones that are going to carry the costs.”
Hoffman said BCBS has held a contract with OU Health Physicians for a minimum of 20 years. Technically, the last contract ended in 2019, he stated, however OU Health Physicians requested for a few extensions due to the fact that of the COVID-19 pandemic. Now, they’ve brought in a brand-new arbitrator from the West Coast, who Hoffman stated was comparing OU Health’s reimbursement rates to those offered in other parts of the country. BCBS said it negotiates rates with physician groups based on the regional cost-of-living index which Oklahoma has one of the most affordable cost-of-living rates in the nation. This is the first time the health system has actually brought an outdoors mediator the contracts, a representative said.
“Bear in mind, with settlements, anything we come up with our members bear the impact of any costs related to that,” Hoffman said.
BCBS likewise kept in mind that it invested more than $100 million in Oklahoma in 2020 COVID-19 relief, did not get CARES Act funding and provided self-insured companies $20 million in premium credits. Hoffman stated that BCBS was still happy to deal with OU Health to work out a brand-new agreement.
Released at Tue, 02 Mar 2021 21:44:22 +0000