October 6, 2022

UnitedHealthcare, OU Health in contract dispute

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Transplant surgeon Oya Andacoglu, M.D., a member of OU Health Physicians, talks with a patient. OU Health recently went out of network with UnitedHealthcare because the insurance provider wanted to cut rates paid to physicians and facilities. (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 of back and forth, the two sides say they never were close to reaching an agreement on a new contract.

OU Health requested rate increases to offset the growing costs of caring for patients, while UHC wanted to cut the rates it had been paying by 39% for physicians and 20% for facilities.

The result is the OU Health system went out of network with UHC on May 1.

“It is more than deeply disappointing that UnitedHealthcare proposed such draconian cuts to our contract,” said OU Health President and CEO Richard Lofgren, M.D. “It is simply unacceptable for us to agree to such a drastic cut which would force us to cut the pay of our physicians, nurses and employees, further limiting Oklahomans’ access to the unique and advanced specialty and subspecialty services OU Health provides to the region.”

OU Health said the last rate increase it proposed in April was less than the current rate of inflation.

UHC spokesman Spencer Leuning said OU Health initially sought a 40% price hike over three years, or nearly $49 million over the span of the contract. Its most recent proposal – for a one-year contract – would be 34% more costly than other hospitals in Oklahoma City, he said.

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

But OU Health provides certain types of care not available anywhere else in the state, said Robert Mannel, M.D., director of OU Health Stephenson Cancer Center. To receive the same quality of cancer care or children’s comprehensive services, patients would have to travel to Texas, he said.

“That clearly is weighing heavily on our minds right now,” Mannel said.

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

“You cannot stop chemotherapy. You cannot stop radiation without harm,” he said. “We made the decision to continue the care through Aug.1 and not bill them because you cannot pull the rug out on these patients.”

Mannel said 20% of the patients at Stephenson Cancer Center are taking part in clinical trials for drugs they cannot get anywhere else in Oklahoma and one in 12 patients have UHC insurance.

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

“He’s alive today, enjoying his family and enjoying his life,” Mannel said. “Just multiply that by hundreds and that’s what I’m dealing with right now.”

COVID-19, staffing shortages, the increasing costs of health care delivery and inflation have resulted in a “substantial increase in the cost of doing business,” he said.

Not to mention patients are coming in with more advanced stages of cancer after skipping regular screenings during the pandemic, he said.

Considering everything, Mannel said it is unrealistic for UHC to propose such “draconian cuts,” especially at a time when their profits have hit record highsending 2021 with $17.3 billion in total profit.

In the past year, OU Health entered into a contract renegotiation with Blue Cross and Blue Shield of Oklahoma and was able to reach a three-year agreement, he said.

“We are still hopeful that United will step back and reconsider,” Mannel said. Patients need to tell their employer they are disappointed, and employers need to let UnitedHealthcare know, he said.

UHC stated, “Our top priority is to renew our relationship with the health system at market-competitive rates so that our members have access to affordable health care.”





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