Blue Cross Blue Protect Oklahoma, doctor group attain contract deal

Blue Cross and Blue Protect of Oklahoma stated Wednesday it reached an settlement with the state’s largest doctor group, simply weeks earlier than the transition interval out of its contract with OU Well being Physicians was set to finish.

The brand new settlement will impression BCBS Oklahoma’s greater than 830,000 members. The 2 teams will lengthen their contracts by way of June 2022 and, over the following 12 months, BCBS Oklahoma and OU Well being can even work to outline a brand new, long-term settlement.

“We worth our long-standing relationship with OU Physicians and are happy to succeed in an settlement that’s in the perfect curiosity of all BCBSOK members, together with group, retail and tribal residents,” BCBSOK President Joseph R. Cunningham stated in an announcement. “This settlement aligns with our dedication to supply entry to high quality, cost-effective healthcare for all Oklahomans.”

The 2 teams introduced in March that that they had not been capable of attain an settlement, after negotiations stretched for a minimum of a 12 months. Their final contract led to 2019, however the COVID-19 pandemic had stalled negotiations.

OU Well being Physicians accused the insurer, which is an affiliate of Well being Care Service Company, of utilizing its “unequaled market share” to sturdy arm its physicians into accepting low charges, which contributed to the state’s doctor scarcity. The well being system added that BCBS Oklahoma generated “windfall income” throughout the pandemic, because of members’ deferred care. For a few years, BCBS Oklahoma was the one insurer working on the native ACA alternate. In 2018, it held all the market share on {the marketplace}, in line with the Robert Wooden Johnson Basis.

The not-for-profit insurer, for its half, known as OU Well being’s reimbursement request “extreme,” including that the group is looking for greater charges whereas providing no new entry to look after its members.

It accused the hospital system of bringing in a negotiator from the West Coast, who in contrast the charges Oklahoma physicians obtain with out-of-state-providers. BCBS stated it negotiates charges with doctor teams based mostly on the native cost-of-living index, and that Oklahoma has one of many lowest cost-of-living charges within the nation. If the insurer had been to bend to OU Well being’s proposed charges, the employee-owned insurer stated the elevated charges could be handed on to members through greater premiums and “considerably increase healthcare prices for sufferers.”

OU Well being makes up 1,000 suppliers of the 21,000 suppliers in BCBS’ essential PPO community. The insurer stated it had held a contract with OU Well being for a minimum of 20 years. OU Well being stated it offered providers to roughly 131,600 BCBS insured sufferers in 2020.

“OU Well being Physicians is happy to have reached a 13-month settlement with BCBSOK,” Dr. John Zubialde, president of OU Well being Physicians and government dean of the College of Oklahoma’s School of Drugs, stated in an announcement. “Offering entry to extremely specialised healthcare providers for our BCBSOK-insured sufferers is a unified objective between our two organizations. Right this moment’s announcement is particularly important for our critically-ill sufferers who will proceed to learn from entry to the state’s largest and most specialised group of physicians.”

This is not the one contract dispute BCBS Oklahoma has run into not too long ago. The insurer and Saint Francis Well being System failed to succeed in an settlement in early Could. The Tulsa-based hospital community accused the insurer of fixing the contract agreements on the last-minute, and making an attempt to hoodwink Saint Francis into paying decrease charges.



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