A disagreement over provider reimbursement rates could lead to more than 830,000 patients left to foot the bill at the state's largest physician group.
Blue Cross and Blue Shield of Oklahoma and OU Health Physicians have yet to finalize a contract for 2021. If they do not come to an agreement by Feb. 28, OU Health Physicians and BCBS of Oklahoma will enter a 120-day transition period, where the insurer's members can still receive in-network treatment through June 28. At that point, OU Health Physicians will be considered out of network for BCBS of Oklahoma members.
"Over the past several years, BCBS has gained unequaled market share and influence over the Oklahoma market and has made record profits going into the pandemic," OU Health Physicians said in a statement. "Now, during the pandemic, they have recorded windfall profits, and yet they are undervaluing Oklahoma's research physicians."
OU Health Physicians said that BCBS' rates have contributed to the state's physician shortage. A 2017 study by the Kaiser Family Foundation found that Oklahoma has 85 physicians per 100,000 people, compared to a national average of 260 providers per 100,000 individuals. If BCBS and OU Health Physicians were unable to reach a contract, the group added that it would force patients to travel hundreds of miles to find in-network specialty care and drive healthcare dollars out of state.
BCBS, meanwhile, called OU Health Physicians' reimbursement request "excessive," adding the group is calling for higher rates while offering no new services for its members. If BCBS were to pay the higher prices called for, the employee-owned insurer said the increased rates would "significantly raise healthcare costs for patients."
"This demand would make OU Physicians one of the highest-paid physician groups not just in Oklahoma, but in the United States, for the same services provided to our members today," BCBS said in a statement.
The not-for-profit said it negotiates rates with physician groups based on the cost-of-living index and that Oklahoma has one of the lowest cost-of-living rates in the nation. BCBS also noted that it spent more than $100 million in Oklahoma in 2020 COVID-19 relief and offered self-insured employers $20 million in premium credits. The company added that it is not an insurer's job to fund ongoing physician training at an academic hospital.