UnitedHealthcare, OU Health in a contract dispute

Transplant surgeon Oya Andakoglu, MD, a member of the OU Health Physicians, talks to a patient. OU Health recently left the UnitedHealthcare network because the insurance provider wanted to reduce tariffs paid to doctors and restaurants. (Photo courtesy of OU Health)

OKLAHOMA CITY – Failed negotiations between OU Health and insurance provider UnitedHealthcare have created a dilemma for some of the state’s most seriously ill patients.

Despite five months back and forth, the two sides say they have never been close to reaching an agreement on a new treaty.

OU Health demanded an increase in rates to offset rising patient care costs, while UHC wanted to reduce tariffs, which it paid by 39% for doctors and 20% for facilities.

As a result, OU’s healthcare system went offline with the UHC on May 1.

“It is more than deeply disappointing that UnitedHealthcare has proposed such draconian cuts to our contract,” said Richard Lofgren, MD, president and CEO of OU Health, MD. reduce the pay of our doctors, nurses and staff, which further limits Oklahoma residents’ access to the unique and advanced special and subspecialty services that OU Health provides in the region.

OU Health said the latest interest rate increase proposed in April was less than the current inflation rate.

UHC spokesman Spencer Löning said OU Health had initially sought a 40% price increase over three years, or nearly $ 49 million during the contract period. His latest offer – for a one-year contract – would be 34% more expensive than other hospitals in Oklahoma City, he said.

The UHC noted on its website that members can choose from 15 hospitals in the Oklahoma City area that are still online, as well as many primary care physicians and specialists.

But OU Health provides certain types of care that are not available anywhere else in the state, said Robert Manel, Ph.D., director of OU Health Stephenson Cancer Center. To receive the same quality of cancer care or comprehensive child care services, patients will need to travel to Texas, he said.

“It obviously weighs heavily on our minds right now,” Manel said.

The Stephenson Cancer Center requested a three-month extension of coverage for 522 patients so they could arrange treatment at another facility, but received a response for only a third of them and all of them were for one-day office visits, Manel said.

“You can’t stop chemotherapy. “You can’t stop radiation without harm,” he said. “We decided to continue caring until August 1 and not charge them because you can’t get the carpet out for these patients.”

Manel said 20 percent of patients at the Stevenson Cancer Center are in clinical trials for drugs they can’t get anywhere else in Oklahoma, and one in 12 patients has UHC insurance.

A man who was diagnosed with stage four colon cancer more than three years ago and was told he had five weeks to live was included in a clinical trial and responded.

“He is alive today, enjoying his family and enjoying his life,” Manel said. “Just multiply that by the hundreds and that’s what I’m doing right now.”

COVID-19, staff shortages, rising health care costs and inflation have led to “significant increases in the cost of doing business,” he said.

Not to mention that patients come with more advanced stages of cancer after missing regular screenings during the pandemic, he said.

All in all, Manel said it was unrealistic for the UHC to offer such “draconian cuts”, especially at a time when their profits had reached record highs.ends 2021 with a total profit of $ 17.3 billion.

Last year, OU Health negotiated a contract with Blue Cross and Blue Shield of Oklahoma and managed to reach a three-year agreement, he said.

“We still hope that United will step down and reconsider,” Manel said. Patients should tell their employer they are disappointed, and employers should notify UnitedHealthcare, he said.

UHC said: “Our top priority is to renew our relationship with the healthcare system at competitively priced prices so that our members have access to affordable healthcare.

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