If United Healthcare and hospitals fail to agree to the new contract by March 31, thousands of Oregonians could lose in-network access to OHSU doctors.
ORESTORGON, USA — Oregon University of Health & Science and UnitedHealthcare have reached a “good faith agreement” on a new contract, according to a hospital system statement on Friday. About 74,000 Oregon people are looking for a new doctor at the end of March if both parties do not finalize the deal.
Healthcare providers like OHSU have contracts with insurance companies and agree to the reimbursement rates that insurers pay for their health services. However, United's contract with OHSU ends on March 31, and unless they negotiate with something new by April 1, OHSU doctors will be “out of the network” of United Insurance patients.
That means United patients can still go to OHSU doctors, but that would cost them significantly, and OHSU says that patients may not even be able to stay in the hospital. If patients remain on March 31, OHSU said on that website It's about making sure they're stable, but on April 1st, patients may be asked to find a hospital that is still in United's network.
All United patients will need to find a new doctor within United's network, but appointments with specialists in particular can be months away.
OHSU said patients can seek United.”Continuity of care“We will be offering our services by April 30th, but there is a unified view of whether they approve it or not.
In a statement banner The hospital system posted on OHSU's website on Friday evening shows that they could be close to a deal.
“We are pleased that OHSU, Adventist Health Portland and Hillsborough Medical Center have each reached a good faith agreement with UnitedHealthcare and are working to finalize the agreement before the expiration date.”
Both United and OHSU have declined to interview KGW.
OHSU says “operational and economic issues” with United are disrupting care. OHSU denied claims of more than 56% compared to the industry standard of 5% to 10%, adding that it takes an average of 307 days (almost a year) to resolve the claims.
United have not responded to those claims, but they say they are fighting against “irrational price increases.” OHSU's proposal agreementclaims that if OHSU agrees to what they want, C-section will cost $9,000 more than today. The outpatient surgery costs an additional $3,000. And an ER visit costs another $1,100.
OHSU responded to an email from KGW regarding the claims, saying it had not confirmed the cost claims and could not confirm how United calculated those numbers.
Meanwhile, both sides say they are still at the negotiation table, so it is possible that the deal will be reached by April 1st.
Becky Haltberg, president and CEO of the Oregon Hospital Association, said in part:
“We've seen an increase in friction between insurance companies and healthcare providers since the pandemic. It really comes down to basic mathematics. Hospitals aren't getting paid enough to cover the cost of care for patients.”
“Over the past few years, some insurance companies have pocketed record profits, when about half of Oregon's community hospitals were consistently operating in red. This is a serious issue that all Oregonians should be concerned about because Oregonians can't work in red indefinitely about all organizations, or anything like that,” Hultberg said.
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