UnitedHealthcare insurance customers may soon find OHSU out-of-network

Roughly 74,000 patients insured through UnitedHealthcare may no longer be able to see providers in-network at Oregon Health & Science University’s hospital and clinics starting next month, as the health system and insurer remain deadlocked in negotiations.

OHSU’s contract with UnitedHealthcare expires on March 31. If the two can’t strike a deal by then, OHSU and its affiliates Hillsboro Medical Center and Adventist Health Portland, will get dropped from UnitedHealthcare’s in-network provider list.

The health system and the insurer each said they’ve notified patients enrolled in UnitedHealthcare employer-sponsored commercial and Medicare Advantage health plans, as well as those who have benefits through a group plan sponsored by a former employer, that they might lose in-network access to OHSU’s hospitals, facilities and health care providers starting April 1.

OHSU has already stopped scheduling appointments beyond March for patients with UnitedHealthcare insurance, saying it “made this decision to respect regulatory guidelines and to protect patients from potentially high financial impact if the contracts expire.” It noted that it would still honor existing appointments that have been scheduled before April 1.

The stakes are high. OHSU operates a complex of hospitals and health clinics, including those branded under the umbrellas of OHSU, Adventist and Tuality, which includes Hillsboro Medical Center.

UnitedHealthcare is the nation’s largest health insurer, with large footprints in Oregon’s commercial and Medicare Advantage insurance markets. UnitedHealthcare provided coverage to roughly 31,500 Oregonians through large-employer plans, according to state data, as well as nearly 61,400 seniors through Medicare Advantage plans. Major employers like Nike contract with UnitedHealthcare to administer their health plans.

Sara Hottman, an OHSU spokesperson, said in a statement that the health institution will continue to negotiate with UnitedHealthcare until the contract end date. She said the two parties began talks to renew their contract last year “but have not achieved mutually agreeable terms.”

She said “operational and financial issues in the UnitedHealthcare contracts have resulted in significant disruption of patient care, which OHSU finds unacceptable and remains a sticking point in negotiations.”

In an email, UnitedHealthcare said it continues to negotiate in good faith with OHSU but accused the health system of being unwilling to compromise.

“OHSU has made little movement in our negotiation and continues to seek a 36% price hike for our commercial plans over two years and a 15% rate increase for our Medicare Advantage plans, which is not sustainable,” a UnitedHealthcare spokesperson said in an email.

The company said OHSU’s proposal “significantly drive-up premiums and out-of-pocket costs for consumers” and impact employers’ ability to “offer affordable health care coverage for their employees.”

Some patients said the public fight makes it seem like the two parties aren’t serious about reaching an agreement.

Roni Goodstein, an OHSU patient with UnitedHealthcare insurance, said letters she’s received from both parties “wanted us to believe they were being wronged.” Goodstein said she and her husband get 90% of their care through OHSU and worry they will have to find new providers, which she said is already difficult given the shortage of primary care doctors.

“Frankly, we do not know what to do,” she said. “Laughingly, UHC directed us to Legacy for care.” Legacy and OHSU announced plans to merge in 2023 and have been pursuing the tie-up since.

The dispute between OHSU and UnitedHealthcare comes as negotiations between insurers and health care providers have grown increasingly contentious.

In January, Providence Health & Services Oregon parted ways with Aetna and Salem Health axed Regence Blue Cross/BlueShield, disrupting care for thousands of patients. Last year, Providence narrowly averted going out of contract with Regence BlueCross/BlueShield. OHSU also came close to severing ties with Aetna but secured a new contract just in time to avoid disruption.

Hospitals contend that higher payments from insurers are essential to cover rising operating costs and to compensate for the financial strain of serving Medicare and Medicaid patients, whose reimbursement rates often fall far short of actual expenses.

Insurers, on the other hand, argue that their rates are in line with industry standards and keep premiums lower for consumers.

OHSU’s contract dispute with UnitedHealthcare also comes as the quasi-public health institution’s contract with PacificSource’s commercial and Medicare Advantage Plans approaches a June 30 expiration. PacificSource notified its Medicare Advantage members of the expiration date in a letter last month.

OHSU, however, said the letter mischaracterized its position by suggesting OHSU plans to leave PacficSource’s provider network. OHSU said it “intends to work toward renewing commercial and Medicare Advantage plans with PacificSource without impact on patients or appointments.”

— Kristine de Leon covers consumer health, retail, small business and data enterprise stories. Reach her at kdeleon@oregonian.com.

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