OU Health out of network with UnitedHealthcare; negotiations ongoing

Oklahoma City-based OU Health went out of network with UnitedHealthcare on May 1 amid a disagreement over reimbursement rates, though negotiations are ongoing. The move means thousands of UnitedHealthcare members cannot receive covered care at OU Health facilities, according to KFOR.

OU Health alerted UnitedHealthcare policyholders about the disagreement in March and April.

A contract termination notice was first issued by OU Health in October after initially requesting a 40 percent rate increase over three years, UnitedHealthcare wrote on its website. That request was denied. According to the payer, OU is already the most expensive provider in Oklahoma, and agreeing to the increase would raise healthcare costs by $49 million. 

OU Health wrote on its website that UnitedHealth is refusing to reimburse the health system at a rate that keeps up with inflation. The provider claims it is being asked to take a 39 percent rate cut for physicians and 20 percent cut in its facilities amid a time when UnitedHealth's profits are at record highs.

"Even with those modest hikes we would not break even compared to previous years because of the increase in costs of staff," Robert Mannel, MD, director of the OU Health Stephenson Cancer Center, told KFOR.

Since the original denial, OU Health has countered with at least five more proposals with lower rates, according to Dr. Mannel. 

The most recent request is a one-year deal that would make OU Health 34 percent more expensive than other Oklahoma City hospitals, according to UnitedHealthcare.

"If we agreed to its current proposal, the cost of care at OU Health's hospitals would be 34 percent higher than the average cost at other hospitals in Oklahoma City," UnitedHealthcare wrote. "OU Health seems to believe that it's entitled to be paid significantly more than its peers and top providers."

The payer wrote that it does recognize the unique services offered at OU Health and said it does reimburse for those accordingly.  

"We urge OU Health to accept our latest proposal without further delay and restore network access for the people and communities we serve so they can have access to care at an affordable cost."

OU Health said UnitedHealthcare is no longer responding to requests to discuss allowing it back in network or to discuss continuity of care for patients, according to KFOR.

Dr. Mannel told KFOR that OU Health is offering continuity of care for office visits to all UnitedHealthcare members over the next three months.

OU Health is composed of the OU Medical Center hospitals in Oklahoma City and Edmond, the Children's Hospital, OU Physicians clinical practices, OU Children's Physicians, the University of Oklahoma College of Medicine, and the Stephenson Cancer Center. The system employs more than 1,300 physicians and includes the state's only full-service children's hospital and level 1 trauma center.

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