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Oregon Health & Science University warned 74,000 patients covered by UnitedHealthcare that they may lose access to OHSU hospitals and clinics unless difficult negotiations with the insurer result in an agreement before the existing contract expires on March 31.
“Despite our best efforts to renew the contracts, OHSU, Hillsboro Medical Center and Adventist Health Portland have not reached mutually agreeable terms with UnitedHealthcare for 2025,” OHSU said in a statement. Hillsboro Medical Center and Adventist are partners that share patients and providers with OHSU.
OHSU said it sent letters to patients covered by UnitedHealthcare to tell them that their doctors may not be in the insurer’s network after March 31.
UnitedHealthcare, the largest health insurer in the U.S., says OHSU is asking for a 36% price increase for its commercial plans over two years, in addition to a 15% increase for Medicare Advantage plans. Together, those changes would raise healthcare costs for people and employers in Oregon by $88 million, UnitedHealthcare said on a webpage set up to describe the impasse.
“Excessive rate increases drive up overall health care costs, directly resulting in a financial strain for the people we serve,” UnitedHealthcare says on the site. “OHSU’s proposal would make it the most expensive health system in our Medicare Advantage network in the Portland metro area and would significantly exceed the average cost of all other providers in our Medicare Advantage network in the state.”
The fight comes as OHSU tries to boost revenue to cover costs for wages and supplies that rocketed during the pandemic and remain stubbornly high. OHSU is waiting for regulators to approve its purchase of Legacy Health, which faces similar struggles.
Such battles are becoming common in the healthcare industry. Aetna dropped Providence Health & Services from its network on Dec. 31 after months of negotiations came to naught.
Under terms that OHSU is proposing, a c-section birth would cost $9,000 more, UnitedHealthcare said on its webpage. The average cost of a typical outpatient surgery would increase by more than $3,700. An emergency room visit would increase on average by about $1,100.
On its own page about the UnitedHealthcare talks, OHSU says people in an OHSU hospital on March 31 could be forced to move.
“Your providers will care for you until discharge, but UnitedHealthcare may ask you to transfer to an in-network hospital,” OHSU says. “Call UnitedHealthcare’s customer service for details.”
Patients covered by UnitedHealthcare who have surgery before the contract expires may be able to get ongoing care at OHSU if they are in treatment for certain conditions, such as cancer or terminal illness. OHSU says exceptions are up to UnitedHealthcare.
OHSU said it is willing to let the contract expire because the terms make it “hard to offer the level of care we want to provide. This will not be a decision made lightly. We hope we can reach a fair agreement without impacting patient care.”