BCBSOK, OUHP Settle Dispute, Work Toward Long-Term Contract

After months of negotiations, Blue Cross and Blue Shield of Oklahoma (BCBSOK) and OU Health Physicians (OUHP) settled their dispute and have agreed upon a contract that will keep the provider organization in-network.

The agreement comes three months after BCBSOK announced that the OUHP would not agree to the terms the payer had established and would be out-of-network starting June 29, 2021.

BCBSOK claimed that OUHP demanded an excessive price increase for members to pay for care. Due to this, the contract was not renewed before the February 28 deadline and the provider and health plan were in a 120-day transition period.

“We value our long-standing relationship with OUHP and are pleased to reach an agreement that is in the best interest for all BCBSOK members, including group, retail and tribal citizens,” said Joseph Cunningham, MD, president of BCBSOK.

“This agreement aligns with our commitment to provide access to quality, cost-effective health care for all Oklahomans.”

The new contract is a short-term contract, valid through June 30, 2022. The two systems will work together over the next year to create a new, long-term contract that reflects the quality of their services to members, according to the press release.

“OU Health Physicians is pleased to have reached a 13-month agreement with BCBSOK,” said John Zubialde, MD, president of OUHP and executive dean of the University of Oklahoma College of Medicine.

“Providing access to highly specialized health care services for our BCBSOK-insured patients is a unified goal between our two organizations. Today’s announcement is especially significant for our critically-ill patients who will continue to benefit from access to the state’s largest and most specialized group of physicians.”

BCBSOK provides healthcare plans for more than 800,000 Oklahomans, making it the state’s largest private health insurer.

OUHP is Oklahoma’s largest physician network, consisting of more than 1,300 physicians and advanced practice providers. With many clinic locations across the state, the provider sees nearly one million patient visits each year.

According to the press release, the contract ensures that all OUHP physicians will remain in the following BCBSOK networks with no disruption to service, Blue Advantage PPO, BlueChoice PPO, BlueLincs HMO, BluePlan65 Select, BluePreffered PPO, and BlueTraditional.

In BCBSOK’s original announcement about parting ways with OUHP, the payer offered resources to help members find new in-network doctors and healthcare professionals. The payer also assured members who were being treated for pregnancy, disabilities, acute conditions, or life-threatening illnesses that they would still be able to see their OUHP doctor even after they left the network.

Contract disputes between networks and providers can be common and are usually cost-related.

For example, in February 2020, MEDNAX, a medical staffing firm that specializes in anesthesiology, neonatology, obstetrics, and radiology, announced that UnitedHealthcare (UHC) was ending its contract with the organization.

A UHC spokesperson said MEDNAX was demanding high reimbursement rates that were 60 percent above the rates of similar healthcare services in the area. These high rates would have increased healthcare spending for members.

UHC also ended contracts with Houston Methodist Hospital, citing finances as the reason.

In the past, contract disputes also generated negative consequences for patients, primarily through surprise billing.

Surprise billing is when a patient receives a medical bill for an out-of-network service delivered at an in-network facility.

Congress passed the No Surprises Act that seeks to eliminate surprise billing, as patients are not always prepared to cover unexpected medical bills. When payers and providers are in a contract dispute, it can lead to a lapse in coverage that often catches members unprepared for a sudden spike in healthcare costs.

As a result, if a plan and provider cannot reach an agreement as BCBSOK and OU were able to achieve, the provider must alert patients 90 days in advance of the transition period and the payer will continue to cover the provider as in-network during that period so that the patients have time to re-evaluate their healthcare delivery options.