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Frequently Asked Questions

What is happening between OU Health Physicians and Blue Cross and Blue Shield?

OU Health Physicians is currently in active negotiations on a new contract with Blue Cross and Blue Shield (BCBS) but have been unable to finalize the terms for a renewal. We are deeply concerned about not reaching an agreement in the middle of an unprecedented pandemic.

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Why is this happening? Why is OU Health Physicians negotiating a new contract?

OU Health Physicians values our long-standing relationship with BCBS both as a network provider and customer, as our employees also receive BCBS health insurance coverage. What we are asking is simple – that the best interest of Oklahomans is kept in mind and that BCBS agrees to compensate OU Health Physicians at rates comparable to the value that our providers bring to the state and region. Rates of payment for physician services need to be commensurate with the market.

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Why do the rates being paid by BCBS need to increase?

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 BCBS members.

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Is OU Health Physicians making investments in care delivery and improved patient outcomes?

Yes. We continue to make large investments in technology and care delivery. In fact, we are investing $213 million over a 5-year period in an Epic digital health strategy and an electronic medical record. OU Health Physicians expects BCBS to pay their fair share of investments that benefit all patients. At the current rates of payment for physician services, they are not paying their fair share.

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What happens if OU Physicians is not able to reach an agreement with BCBS?

If we are unable to reach an agreement before February 28, 2021, OU Physicians and BCBS will enter a 120-day transition period where you can continue to receive treatment from your OU Health Physicians on an in-network basis through June 28, 2021. However, unless an agreement is reached, beginning June 28, 2021, our providers will be considered out-of-network for BCBS health plan members. If we do go out-of-network, BCBS members will have to pay more out-of-pocket costs to receive care from OU Health Physicians.

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How can I stay updated on OU Health Physicians’ status with BCBS?

We will continue to keep our patients, staff, stakeholders, and leaders updated as contract discussions progress. You can access updates on our website at www.ouhealth.com/bcbsinfo.

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Why is it important that OU Health Physicians remain in-network for our patients insured by BCBS?

OU Health Physicians is the largest multispecialty group in Oklahoma and offers a depth and breadth of clinical services not otherwise available to the patients in our region. In 2020, OU Health Physicians provided services for approximately 131,600 BCBS-insured patient visits.
This included:

  • Pediatric cancer care for over 500 BCBS children at the Jimmy Everest Center for Cancer and Blood Disorders in Children. OU Health 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 1,100 BCBS premature infants at OU Health 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 5,600 BCBS children. OU Health 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 OU Health 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 4,000 BCBS 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 becomes out-of-network, BCBS 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.

We remain deeply concerned that, at the height of the COVID-19 pandemic, our doctors will be out of network to treat patients inside of our hospitals.

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Will patients have to go to other facilities, if OU Health Physicians are no longer in network?

  • We remain deeply concerned about the patients that must be served within an inpatient setting and must receive care at our hospital partner, University of Oklahoma Medical Center. OU Health Physicians is a highly trained faculty practice serving thousands of patients across Oklahoma in clinic and hospital settings.
  • The 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 may have to travel out of state to receive this care.

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What is the status of discussions?

OU Health Physicians is committed to working with BCBS to reach a fair resolution that maintains our in-network status and long-standing relationship with BCBS. While we are committed to ongoing discussions, we have key issues to resolve in a short amount of time.

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What if I have an appointment with my provider scheduled on or after March 1, 2021 and OU Health Physicians hasn’t reached an agreement with BCBSOK?

Please know that these negotiations are currently ongoing. Hopefully, nothing changes for you regarding your insurance plan. However, there will be a 120-day transition period where BCBS members can continue to access OU Health Physicians providers on an in-network basis beginning March 1, 2021. If you have an appointment scheduled between now and June 28, 2021, you can call OU Health Physicians at (405) 271-5258 to confirm.

BCBS members’ out-of-network access to care at OU Health Physicians clinics (beginning June 28, 2021) will vary based on their specific health plan benefits. Certain patients may qualify for Continuity of Care benefits for a period of time if our contract does expire. If you have questions or concerns, including those pertaining to benefit level determinations, you are welcome to call OU Health Physicians at (405) 271-5258. Additionally, you can call BCBS in Tulsa directly at (918) 551-3500 or toll free at (866)-520-2507 to understand your out-of-network benefits. If possible, we encourage all patients to reschedule appointments to a date prior to June 28, 2021 to ensure in-network care is received.

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What is Continuity of Care?

In the situation that OU Health Physicians’ contract with BCBS expires, Continuity of Care provisions would allow certain current BCBS members to continue receiving care from their OU Health Physicians health care providers for specific treatments and conditions. While there is no language in the current OU Health Physicians contract with BCBS regarding Continuity of Care, there is language in the Oklahoma Administrative Code that specifies that BCBS is responsible for providing continuity of care for HMO members with certain conditions.

Patients should call BCBS in Tulsa at (918) 551-3500 or toll free at (866)-520-2507 to find out if they are eligible and to apply for Continuity of Care. When calling BCBS, please record the reference ID number you are provided and the name of the representative with whom you speak. This will help us if we need to make additional follow up with BCBS on your behalf.

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What if I am pregnant or seeing a provider for a special condition on or after June 28, 2021 and OU Health Physicians hasn’t reached an agreement with BCBSOK?

Certain patients may be able to continue receiving care for a limited time through Continuity of Care benefits. If you are concerned, call the BCBS numbers above, or the number on the back of your BCBS insurance card to see if you qualify and, if so, how to apply.

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