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Fact vs. Myth


1. BCBS MYTH: OU Health Physicians says the existing contract payments are not sustainable. BCBSOK pays OU Health Physicians fair prices based on the value of services delivered, as we have done since their inception in 1991. Now, during a global pandemic, OU Health Physicians is demanding an excessive increase well above the current reimbursement rate, without any additional access to care for our members. This demand would make OU Health 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. OU Health Physicians has not offered any guarantee of extra services or improved outcomes with their demand for more money.

FACT: The truth is that all OU Health Physicians wants is to be valued at the same level that other commercial insurance companies pay research-driven physicians in Oklahoma and across the country. BCBS pays OU Health Physicians far less than what their competitors pay us. We only ask that BCBS pay what the other large national companies like United and Aetna pay. BCBSfalsely claims that we are asking for “excessive increases” from BCBS. Our state deserves and needs a level of healthcare that can only be provided if BCBS pays a fair rate to OU Health Physicians.Those rates of payment need to be commensurate with the market. We are not asking for more than what is reasonably necessary to continue providing high-quality care to patients, nor more than what other major, national health plans are already paying.

BCBSOK states this would make OU Health Physicians one of the highest paid physician groups not just in Oklahoma but across the country. This is simply not true. Many national groups contract for rates at or near 300% of Medicare. We are not asking for anything like that..

OU Health Physicians’ top priority is our patients and their continued in-network access to high-quality, lifesaving care from the physicians they know and trust.

OU Health Physicians’ equipment, technology and healthcare support staff expertise makes many of our essential services impossible to replicate at other facilities. OU Health Physicians is inextricably linked with these hospital services and our physicians must remain in network in order to continue delivering the clinic and hospital care Oklahomans need. Without these services, Oklahomans will have to travel out of state to receive this care.

OU Health Physicians continues to invest in our patients through technology and care delivery. OU Health Physicians has partnered with OU Health hospitals on investments into our patient experience, electronic health record system, quality improvement initiatives, and telehealth.

2. BCBS MYTH: OU Health Physicians says BCBSOK has not been willing to provide parity to the state’s most specialized group of research physicians, compared to what it pays other groups in other states. We pay OU Health Physicians, and all our in-network medical professionals, fair market prices based on the value of their services. As a health insurer, we do not interfere with OU Health Physicians’ ability to attract and retain specialized groups of research physicians.

FACT: OU Health Physicians’ ability to recruit and retain is directly tied to the reimbursement we receive for their services. BCBSOK parent company HCSC’s windfall profits was more than 14% this year compared to United Healthcare’s profits of less than 8%.

Blue Cross Blue Shield is undervaluing OU Health Physicians which makes it difficult to attract and retain enough physicians to care for the citizens of our state. Oklahoma needs OU Health Physicians to attract the brightest doctors, healthcare researchers, and educatorsacross the national healthcare landscape. This research-driven talent works together to deliver healthcare available nowhere else in the state, along with cutting-edge research that can bring access to the latest treatment options for patients.

3. BCBS Myth: OU Health Physicians says they continue to make large investments in technology and care delivery and expect BCBSOK to pay their fair share of investments, like the $213 million, 5-year agreement with Epic software. As stewards of our members’ health care dollars, we cannot, in good conscience, allow OU Health Physicians to fund their investments on the backs of BCBSOK members, which will raise rates and increase out-of-pocket costs. This is our members’ money and OU Physicians wants them to pay more.

FACT: We are not asking BCBSOK for additional funding beyond rates comparable to BCBSOK’s competitors. BCBSOK is purely and simply undervaluing OU Health Physicians, which cuts short our ability to attract the talent that helps us advance treatment options fueled by innovation and research discovery.This innovation comes only from a highly specialized physician research group.

Research-driven physician groups provide access to doctors and treatment available nowhere else in a state or region, benefiting the individual patient, the state, and all of healthcare through unique treatment that leads to life-saving discoveries. OU Health Physicians also trains the next generation of Oklahoma physicians. For years, BCBS has underpaid OU Health Physicians, bringing harm to our state by preventing us from adequately recruiting and retaining the talent needed for furthering our mission for Oklahoma.. Over the past several years, BCBS has gained unequalled market share and influence over the Oklahoma market and has made record profits going into and throughout the pandemic. We cannot meet our clinical, academic, & research missions if BCBS undervalues us and continues to hold onto their profits to the detriment of our patients.

4. BCBS Myth: OU Health Physicians says BCBSOK is undervaluing OU Health Physicians by paying them far less than other research-based physician groups across the country. BCBSOK reimburses providers based on the cost of delivering care in Oklahoma, not what the rates are nationally, including the east and west coasts. Oklahoma’s cost-of-living index is considered one of the lowest in the United States, per the National Cost of Living index. The rates we negotiate must be appropriate and align with the cost of living in our state. After all, it’s the people of Oklahoma who seek care from OU Health Physicians.

FACT: OU Health Physicians is comparing BCBSOK to their local competitors, United, Aetna, Humana, etc. OU Health Physicians expects all commercial payers to pay similar, competitive rates for physician services. The existing contract payments are not sustainable for OU Health Physicians to continue providing quality physician services to BCBSOK members.

By taking the stance that it is, BCBSOK is using its market influence to pay OU Health Physicians less than anyone else. Such unfair leverage in the marketplace is driving patients, and money, out of Oklahoma. In addition, by undervaluing OU Health Physicians in the marketplace, it is more difficult to attract and retain healthcare talent for Oklahoma.

5. BCBS MYTH: OU Health Physicians says BCBSOK is undervaluing OU Health Physicians, cutting into their investment to train physicians during a physician shortage where Oklahoma needs more access to doctors. It is not the role of a health insurer to fund ongoing physician training at an academic hospital. Our role is to provide our members access to quality, affordable health care.

BCSBOK acknowledges the physician shortage in Oklahoma and because we are committed to providing our members access to care now and in the future, we’ve partnered with the State of Oklahoma and the Physician Manpower Training Commission (PMTC) to support the Physician Loan Repayment program. The PMTC grant program invests in reimbursing health care students for a portion of their education loans, in exchange for working or practicing in rural and underserved parts of the state.

FACT: OU Health Physicians and the University of Oklahoma College of Medicine clinical departments fund approximately 65 resident positions at a cost of $5 million per year over and above what is received from the state for trainingnew physicians for Oklahoma. This far and away overshadows the support BCBS provides to PMTC.

By undervaluing OU Health Physicians, Blue Cross Blue Shield reduces our ability to improve Oklahoma’s health. OU Health Physicians trains 80% of the physicians in Oklahoma. Oklahoma has a physician shortage, ranking 47th in the country for physicians per capita. It is far too important for OU Health Physicians to be able to be a part of educating Oklahoma’s doctors. Creating more access to doctors in our state is critical in creating a healthier Oklahoma.

6. BCBS MYTH: OU Health Physicians says they need YOUR health care dollars to invest in research. As academic research physicians, OU Physicians has their research and technology investments paid through federal and private grants. BCBSOK members buy health insurance for peace of mind, to pay for their medical care and protect them from overwhelming health care costs, not to fund research projects for OU Health Physicians.

FACT: OU Health Physicians is not asking for support to fund our research projects; we are simply noting that our specialized physicians are both clinicians and scientists, and as such, we recruit against other national academic medical centers such as MD Anderson, Johns Hopkins, Stanford, and others. , This requires competitive reimbursement.

Our physicians bring their evidence-based medicine approach to providing highly sub-specialized clinical services to Oklahoma. Over the past several years, BCBS has gained unequalled market share and influence over the Oklahoma market and has made record profits going into the pandemic. Now, during the pandemic, they have recorded windfall profits, and yet they are undervaluing Oklahoma’s research physicians. We are asking them to reinvest in Oklahoma. They falsely claim that we are asking for “excessive increases” from BCBS. The truth is that all we want is to be valued at the same level that other commercial insurance companies pay research-driven physicians in Oklahoma and across the country. Our state deserves and needs a level of healthcare that can only be provided if BCBS pays a fair rate to OU Physicians.

7. BCBS MYTH: OU Health Physicians says they are committed to ongoing discussions. OU Health Physicians has hired a third party, out-of-state consultant to negotiate their agreement in an effort to gain exorbitant rate increases from our members. This is out of touch with what Oklahomans can support, especially during the pandemic. The consultant is driving up health care costs in our state that will impact all Oklahomans.

FACT: BCBSOK charges the same premiums as their competitors; we simply want them to reimburse OU Health Physicians at the same rate as these same competitors.

It is not unusual, and is often customary, for a physician practice to engage a consultant to assist in complex negotiations with payers such as BCBS. Negotiationswith insuranceproviders require a huge time commitment. It takes valuable patient care and practice management time for OU Health Physicians providers and administrative staff to undertake these negotiations without assistance from an organization that has years of experience negotiating these types of contracts. Our national consultant with healthcare expertise has immense insight into working with a national insurance company such as BCBS. This is not out-of-touch with Oklahomans, this is OU Health Physicians engaging in difficult and necessary work that we know will benefit all Oklahomans.

8. BCBS MYTH: OU Health Physicians says BCBSOK is taking their record windfall profits from an unprecedented and deadly pandemic and shipping it out-of-state to their corporate headquarters. BCBSOK is a member-owned company and does not pay dividends or answer to shareholders. BCBSOK re-invests profits to develop products and services for members in our state. BCBSOK profits stay in Oklahoma to support our members.

We have deep roots and long-standing relationships in Oklahoma. Our 1,100 employees live and serve in our communities. We are part of a larger organization that shares knowledge and support that helps Oklahomans.

BCBSOK invests in local communities through programs like The Oklahoma Caring Foundation, a 501(c)3 nonprofit organization that supports programs that gives Oklahomans access to preventive health services. We administer these services through the Foundation, which also operates The Oklahoma Caring Van Program, providing immunizations for children at no cost to their families.

In 2020 alone, we spent more than $100 million directly in Oklahoma on COVID-19 relief, without the support of funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This was not to fulfill a government requirement; it was done for our members and Oklahoma because it was the right thing to do.

FACT: OU Health Physicians is asking BCBS to invest in its members and the health of all Oklahomans and help Oklahoma rise from the bottom of the nation in health. BCBS executive compensation and bonuses are publicly available and are exorbitant. Our proposals have not been “excessive.” We think their profits and bonuses are excessive and do not improve the health of Oklahomans. In fact, BCBS’ parent company pays more in executive bonuses annually than they pay to OU Health Physicians for annual reimbursement.

As the largest multispecialty group in Oklahoma, OU Health Physicians has proven it invests in its patients. And, thousands of those patients are BCBS members.

In 2020, OU Physicians provided services for approximately 131,600 BCBS-insured patient visits. This included:

  • Pediatric cancer care for over 500BCBS children at the Jimmy Everest Center for Cancer and Blood Disorders in Children. OU Physicians pediatric cancer and blood disorder specialists are highly specialized and the only physicians caring for pediatric cancer patients in the state. An out-of-network status would cause unnecessary displacement of care for families facing pediatric cancer treatment by forcing them to travel out of state to receive this care.
  • Neonatal/perinatal care for approximately 1,100BCBS premature infants at OU Physicians’ hospital partner, Oklahoma Children’s Hospital OU Health. Oklahoma Children’s Hospital has the state’s only Level IV Neonatal Intensive Care Unit and only neonate-dedicated helicopter that flies across the state and region bringing critically ill babies to the highest level of neonatal care available in Oklahoma. Highly trained neonatologists, pediatric surgeons, pediatric intensivists and more provide this lifesaving care in the hospital setting. The comprehensiveness of the Oklahoma Children’s Hospital care team is unmatched anywhere in the state and not replaceable.
  • Critical care to approximately 5,600BCBS children. OU Physicians pediatric intensive care specialists are highly trained and provide advanced capabilities and expertise, in particular, for children recovering from lifesaving cardiovascular surgeries that no other physicians in the state perform.
  • Cancer care for approximately 3,100 adult BCBS patients at the Stephenson Cancer Center. As the state’s only NCI-Designated Cancer Center, many of these patients were part of 291 clinical trials offered at Stephenson Cancer Center, the majority of which are not available anywhere else in Oklahoma.
  • Lifesaving emergency care to approximately 4,000BCBS patients from across Oklahoma. Patients and their families rely on the state’s only Level I trauma center at University of Oklahoma Medical Center and Oklahoma Children’s Hospital. Many of these patients were transfers from other hospitals across the state who rely on our physicians’ expertise and technologies.

If OU Health Physicians is forced out-of-network, BCBSOK members will likely face higher out-of-pocket costs to continue seeing their trusted providers and to continue receiving services at their trusted OU Health hospital facilities.

9. BCBS MYTH: OU Health Physicians says BCBSOK is using its market power to harm Oklahomans by driving health care dollars out of state and forcing our citizens to have to travel hundreds of miles to find in-network specialty care. Our members have access to one of the largest and most robust health care networks in the state, with coverage in all 77 Oklahoma counties. Our networks consist of approximately 98% of Oklahoma’s practicing health care workers, which involves thousands of primary care physicians and specialists. We also have a program called BlueCard℠ that gives our members the flexibility to seek in-network care nation-wide, should they choose to do so.

FACT: BCBSOK is using their dominant market influence to set the prices they want to pay and undervalue doctors in Oklahoma. Monopolies simply crowd out the competition until there is none left and then they can pay whatever they want.

OU Health Physicians offers an unparalleled depth and breadth of clinical services not otherwise available to the patients in our region. By undervaluing OU Health Physicians providers and services, their members who need these valuable services will be forced to pay much higher out-of-network costs or leave the state for these services, thus driving health care dollars of our state and causing unnecessary costs and burden to BCBS members.

10. BCBS MYTH: OU Health Physicians says you called us heroes, but BCBSOK is undervaluing our role in Oklahoma healthcare. BCBSOK appreciates and acknowledges the dedication of all the health care heroes who have given care to our members throughout the COVID-19 pandemic. As Oklahomans, our gratitude extends to OU Health Physicians, along with all the health care workers across the state, fighting a global pandemic.

BCBSOK also appreciates the front-line heroes who don’t wear scrubs, such as essential employees like first responders, teachers, grocery and convenience store workers, law enforcement and non-profit workers, just to name a few. Many of these heroes are also our members.

As the state’s largest member and customer-owned health insurer, we have a responsibility to stand with our members and be good stewards of their health care dollars. We manage their dollars by negotiating fair and reasonable rates for all parties, which ensures financial stability and peace of mind.

FACT: BCBSOK pays OU Health Physicians significantly less than the other large national insurance companies.

OU Health Physicians has been proud to serve Oklahomans throughout the pandemic and throughout the multi generations of patients’ lives we have cared for. Our patients are our friends, family and neighbors. Along with their families, they have come to depend on us to help them through what is often the toughest times in their lives. We just want to be able to continue with them on their journey through life. Because, ultimately, our patients are OUR heroes.

BCBS BOTTOM LINE: Despite OU Health Physicians’ attempts to raise our members’ health care costs, we will always protect our members and be good stewards of their health care dollars.

FACT: BCBSOK puts their profits over patients and they are fighting to protect their margins and exorbitant executive bonuses. The only reason Oklahoma’s healthcare costs would increase is if BCBSOK raised member premiums rather than accepted a slightly smaller profit margin which is more similar to other national insurance companies.

The bottom line is this: BCBS has not been willing to provide payments equal to what other insurance companies pay OU Health Physicians, even though we are the state’s most specialized group of research physicians. Instead, they are keeping their record windfall profits from an unprecedented and deadly pandemic, rather than investing it in Oklahoma healthcare. BCBS is using its market influence to harm Oklahomans by driving healthcare dollars out of state and forcing our citizens to have to travel hundreds of miles to find in-network specialty care.

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