OU Board of Regents Chairman Gary Pierson said Blue Cross Blue Shield has neglected the expected 120-day transition period for finding new coverage after no contractual agreement was made with OU Health Physicians by Feb. 28.
March 1 was slated as the first day of a 120-day transition period, wherein insured patients could still receive care from OU Health Physicians and be considered in-network for insurance coverage, according to an email from OU Physicians President and OU College of Medicine Executive Dean Dr. John Zubialde.
However, at the Friday Board of Regents meeting Pierson said the insurer had already halted payment on dozens of OU Health Physicians patients, including chronically-ill children, and OU had to move them to other locations, some out of state.
"I'm not talking one ... but it's a number of infants that didn't get healthcare because of this dispute," Pierson said. "Now that's real life, and that's where we are. I've negotiated a number of things in my life, some successfully, some not, but this is just a plain old bully tactic. That's all it is. They're going to sweat us until they think we're gonna capitulate, and they're going to be really wrong on that. And the people that will pay the price will be the citizens of Oklahoma, because you will be denied the best healthcare in the state."
In a response sent to The Daily by BCBSOK Public Relations Unit Manager Lauren Cusick, the organization wrote it "worked hard to maintain (its) long-standing" relationship with OU Physicians amid its desire to pay all partners "fair, reasonable rates."
"We negotiated in good faith to find a mutually beneficial agreement that was in the best interest of our members. Unfortunately, their demands unreasonably drove up what our members and customers would have to pay for access to care," the statement read. "This is not the outcome we had hoped for, but our networks remain strong and robust and our members will continue to have access to thousands of quality, convenient and in-network providers in the Oklahoma City metro and across the state."
Pierson said the insurer pays OU Physicians 30 percent less in comparison to other insurers, which is why the university moved to cease the "unsustainable" treatment over the past four years. He said the university went to the insurer to "close that gap" to move them on par with other insurers, but BCBS responded with a bid that stated they wanted them to move to 35 percent below market.
"They didn't pay any attention to (the transition period) and just stopped it, on day one or day two. No notice, just stopped. And those kids had to leave," Pierson said. "You're going to hear from them and say 'Chairman Pierson's got his facts wrong,' ... But if you don't want to believe me and don't want to believe them, go talk to the parents of those children and see what they think about this. This is something that needs to be worked out ... this is a big deal, this is as big as it gets because it affects everybody in this state potentially."
In its statement, BCBS wrote its focus now is to "safely transfer" members' care to other in-network providers, but did not immediately deny Pierson's comments regarding stoppage of care for some patients. Cusick wrote in a text message to a Daily editor she would begin investigating those claims Monday.
"BCBSOK members will receive in-network access to the doctors and health care professionals employed by OU Physicians during a 120-day transition period. On June 29, 2021, OU Physicians will leave our provider networks," the statement read. "Our members will continue to have access to many of the same services and specialties OU Physicians provided, through other in-network providers. If a member is concerned about their treatment, they should call the number on the back of their ID card and we can help them find a solution."
The statement also read some members will be eligible for "continuity of care for ongoing conditions" during after the end of the transition period on June 29.
"Benefits for continuity of care are based on the member’s plan. To find out eligibility, members can call the number on their ID card for more information," the statement read.
Pierson said the university will work on reconciling the agreement, and that they will continue asking that OU Physicians see fair treatment compared to other groups.
"You look at the healthcare of this state, this enterprise we're at right now supplies 80 percent of the healthcare workforce of this state," OU President Joseph Harroz said. "It also ... is by far the biggest engine of healthcare-related research, and all of the healthiest states have one thing in common: at least one flourishing, integrated academic health system ... because the treatment you can receive here is different than anywhere else in the state and in the region."
Harroz said what BCBS pays OU Physicians directly translates to the health of Oklahoma citizens, and the idea of OU "rolling over" to accept the gap in payment "harms the state in a direct one-to-one way."
"So if the question is asked where does this board stand and where do I stand? Let me be clear: that's where we stand," Harroz said.
