Thousands of Oregonians may lose in-network access to OHSU doctors if UnitedHealthcare and the hospital can’t agree on a new contract by March 31.
OREGON, USA — Oregon Health & Science University and UnitedHealthcare have reached a “good-faith agreement” on a new contract, according to a statement from the hospital system on Friday. About 74,000 people in Oregon will be looking for a new doctor at the end of March if the two sides do not finalize the deal.
Health care providers like OHSU have contracts with insurance providers, agreeing to reimbursement rates that the insurance company will pay for medical services. But United’s contract with OHSU ends on March 31, and if they don’t negotiate a new one by April 1, OHSU’s doctors will be “out of network” for patients with United insurance.
That means United patients can still go to an OHSU doctor, but it will cost them significantly more, and OHSU says patients might not even be able to stay in the hospital. If patients remain on March 31, OHSU said on its website that it will make sure they are stable, but on April 1, patients may be asked to leave and find a hospital that’s still in United’s network.
All United patients will need to find a new doctor within United’s network — but an appointment, particularly with a specialist, is likely months away.
OHSU said that patients can ask United for “continuity of care” service by April 30, but it is up to United whether they approve it.
In a statement banner posted on OHSU’s site Friday evening, the hospital system signaled that they may be close to a deal:
“We are pleased to share that OHSU, Adventist Health Portland and Hillsboro Medical Center have each reached a good-faith agreement with UnitedHealthcare and and are working to finalize contracts before the expiration deadline.”
Both United and OHSU declined interviews with KGW.
OHSU has said that “operational and financial issues” with United are disrupting care. OHSU added that United denies more than 56% of claims compared to an industry standard of 5% to 10%, and that it takes an average of 307 days — almost an entire year — to resolve claims.
United has not responded to those claims, but they have said they are contending with “unreasonable price hikes” under OHSU’s proposed contract, claiming that if they agree to what OHSU wants, a C-section would cost $9,000 more than it does today; outpatient surgery would cost $3,000 more; and an ER visit would cost $1,100 more.
OHSU responded to an email from KGW regarding the claims, saying they haven’t reviewed the cost claims and can’t verify how United calculated those figures.
Meanwhile, both sides say they’re still at the negotiating table, so it’s possible they could reach a deal before April 1.
Becky Hultberg, president and CEO of the Hospital Association of Oregon said in part:
“We have seen increased friction between insurers and providers since the pandemic. It really comes down to basic math. Hospitals aren’t being paid enough to cover the cost of caring for patients.”
“Over the past few years, some insurers have pocketed record profits, at a time when about half of Oregon’s community hospitals have been consistently operating in the red. This is a serious issue that all Oregonians should care about because no organization — or household, for that matter — can operate indefinitely in the red,” said Hultberg.