OU Health Physicians, Oklahoma Blues fail to reach new contract

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 the insurer have now entered a transition period, during which Blues members can still receive in-network treatment through June 28. After that, OU Health Physicians will be considered out-of-network.

The health system said it provided services to approximately 131,600 Blues-insured patients in 2020. In a letter to those patients, Dr. John Zubialde, president of OU Health Physicians, said negotiations between the two parties have extended at least a year.

“For years BCBS has underpaid OU Health Physicians, bringing harm to our state by preventing us from adequately investing in education, research and clinical care,” Zubialde wrote, adding that the insurer has “unequaled market share” and recorded “windfall profits” during the COVID-19 pandemic.

In addition, the insurer’s low reimbursement rates have contributed to the state’s physician shortage, Zubialde said, since OU Health Physicians trains 80% of the physicians in Oklahoma. A 2017 study by the Kaiser Family Foundation found that Oklahoma had 85 physicians per 100,000 people, compared with a national average of 260 providers per 100,000 individuals. If the Blues and OU Health Physicians can’t reach a contract, patients would be forced to travel hundreds of miles to find in-network specialty care, the health system contends.

The Blues plan called OU Health Physicians’ reimbursement request “excessive,” adding the group wants higher rates while offering no new access to care for its members.

Dr. Todd Hoffman, the insurer’s chief medical officer, noted it works to address physician shortages by investing in the state’s Physician Manpower Training Commission, which helps healthcare providers repay their student loans by practicing in rural or underserved areas.

“It’s a big deal for the state and for all of us,” he said. “What it all boils down to is we’re going to stand by our members. Do we want OU to be in our network? Absolutely. But we have to have a fair deal for our members. They’re the ones that are going to shoulder the costs.” ●

“For years BCBS has underpaid OU Health Physicians, bringing harm to our state by preventing us from adequately investing in education, research and clinical care.” Dr. John Zubialde, president of OU Health Physicians