OHSU’s New Policy on Out-of-Network Insurance
Oregon Health & Science University (OHSU) is taking steps to handle patient flow when it comes to out-of-network insurance, aiming to support its budgetary needs. This shift could influence where many individuals in Oregon receive their healthcare services.
The recently introduced policy specifies the procedures OHSU administrators must follow when working with patients seeking services at the university.
An OHSU representative stated that the institution would coordinate with the insurance company to secure approval for the service and try to agree on a one-time rate beforehand. If that cannot be achieved, the guidelines will direct patients to another provider or facility that is in-network.
This policy arrives nearly six months after OHSU managed to secure coverage for 74,000 patients insured through UnitedHealthcare. Tense negotiations earlier this year highlight ongoing conflicts in the healthcare sector as costs continue to escalate. Both the hospital system and the insurance provider are trying to safeguard their interests.
OHSU’s leaders express the need to curtail rising expenses to ensure the institution’s future viability.
A university spokesperson mentioned that implementing this approach would help prioritize care for patients who already have contracted plans and assist in financial screenings and lowering self-pay costs for other patients.
It seems OHSU is also quite focused on its own financial health. Like many other healthcare systems in the U.S., it negotiates with private insurers to establish the payment rates for services delivered to their members under various plans. These agreements often determine if a service or plan falls under “contracted” or “network” status.
According to OHSU representative Kristi Cushman, insurance companies that have not participated in such agreements might pay considerably lower rates—or potentially nothing at all.
This situation exacerbates patients’ out-of-pocket expenses as the remaining balance often falls to them. It also means less revenue for OHSU. For patients receiving financial assistance, it indicates they might not have to pay some or any fees.
Cushman provided another justification for the new policy: access to care. With patients currently waiting months for appointments, those with out-of-network plans can occupy valuable slots that could otherwise serve members of contracts with OHSU.
She also noted that many services are available through other facilities in the area, suggesting that, when necessary, OHSU should refer patients to network providers. However, she emphasized caution regarding the implementation of these new policies.
“We have a lot of patients already receiving care from us who have these kinds of plans,” she explained to staff about how the new policy could affect them. “But we shouldn’t disrupt their care either. If we’re the only option for the patient or they’re close to completing their treatment, shifting them makes little sense.”
Community Response and Implications
The changes at OHSU have broader implications for local healthcare laws, prompting action from civic leaders and raising awareness among politicians impacted by these developments.
