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How COVID-19 warped payer-provider contract negotiations
Modern Healthcare Illustration / Getty Images
The COVID-19 pandemic brought on a year of thanking healthcare workers. In Chicago, residents held nightly light shows thanking their providers. In New York City, people sang in the streets.
A year later, some experts believe health systems may be using their post-COVID-19 publicity glow to pressure insurers into rate increases, pointing to a rash of recent tense negotiations erupting into the public sphere. That s something we need to watch out for the, kind of the afterglow of public support, and then the argument that we lost money, we need to make it up, said Glenn Melnick, a professor of healthcare at the University of Southern California, who conducts research on payer-provider negotiations. I do think that we will see that this year and next.
Modern Healthcare Illustration / Getty Images
A disagreement over provider reimbursement rates will soon leave more than 830,000 patients out-of-network at Oklahoma s largest physician group.
Blue Cross and Blue Shield of Oklahoma and OU Health Physicians were unable to finalize a contract for 2021. The health system and BCBS of Oklahoma have now entered a 120-day transition period, where BCBS of Oklahoma 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.
The healthcare system said it provided services to approximately 131,600 BCBS insured patients in 2020. In a letter to these patients, Dr. John Zubialde, president of OU Health Physicians, said negotiations between the two parties have extended at least a year.
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.
A webinar detailing OU Health Physicians’ “ongoing” negotiations with Blue Cross Blue Shield has been rescheduled for noon Feb. 19 due to extreme winter weather.