{"id":2482,"date":"2025-02-07T12:21:27","date_gmt":"2025-02-07T12:21:27","guid":{"rendered":"https:\/\/www.soscip.org\/us\/?p=2482"},"modified":"2025-02-07T12:21:29","modified_gmt":"2025-02-07T12:21:29","slug":"unitedhealthcare-vs-ohsu-denial-rates","status":"publish","type":"post","link":"https:\/\/www.soscip.org\/us\/unitedhealthcare-vs-ohsu-denial-rates\/","title":{"rendered":"UnitedHealthcare vs. OHSU: Denial Rates and Payment Delays Threaten Patient Care"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Oregon Health &amp; Science University (OHSU) has issued a stark warning to 74,000 patients covered by <a href=\"https:\/\/www.soscip.org\/us\/unitedhealthcare-vs-ohsu-denial-rates\/\" data-type=\"link\" data-id=\"https:\/\/www.soscip.org\/us\/unitedhealthcare-vs-ohsu-denial-rates\/\">UnitedHealthcare<\/a>, stating that they may lose access to OHSU hospitals and clinics if ongoing contract negotiations fail. The existing agreement is set to expire on March 31, leaving patients in limbo as both parties struggle to reach common ground.<\/p>\n\n\n\n<div class=\"wp-block-rank-math-toc-block\" id=\"rank-math-toc\"><h2>Table of Contents<\/h2><nav><ul><li><a href=\"#the-core-issue-payment-delays-and-high-denial-rates\">The Core Issue: Payment Delays and High Denial Rates<\/a><\/li><li><a href=\"#financial-struggles-amplify-the-conflict\">Financial Struggles Amplify the Conflict<\/a><\/li><li><a href=\"#peer-to-peer-denials-a-major-pain-point\">Peer-to-Peer Denials: A Major Pain Point<\/a><\/li><li><a href=\"#a-national-trend-healthcare-networks-in-turmoil\">A National Trend: Healthcare Networks in Turmoil<\/a><\/li><li><a href=\"#whats-next-for-patients\">What\u2019s Next for Patients?<\/a><\/li><\/ul><\/nav><\/div>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"the-core-issue-payment-delays-and-high-denial-rates\">The Core Issue: Payment Delays and High Denial Rates<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">According to OHSU, the primary roadblocks in negotiations are UnitedHealthcare\u2019s high claim denial rates and prolonged payment processing times, which the university describes as \u201csignificant disruptions\u201d to patient care. OHSU officials assert that UnitedHealthcare\u2019s denial rate stands at a staggering 56.4%\u2014far above the industry standard of 5% to 10%\u2014and that claim resolutions take an average of 307.3 days, making it the slowest among OHSU\u2019s insurance partners.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">UnitedHealthcare, however, disputes these claims. The company states that it pays 98% of all claims submitted correctly and in a timely manner, with only 0.5% of denials being based on clinical evidence and patient safety concerns. The remaining 2% of denials, according to UnitedHealthcare, result from services not meeting benefit criteria established by employers, state regulations, or the Centers for Medicare &amp; Medicaid Services (CMS).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.soscip.org\/us\/blue-cross-blue-shield-settlement\/\" data-type=\"post\" data-id=\"2180\">Blue Cross Blue Shield Settlement 2025: What It Means for You &amp; Your Healthcare<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.soscip.org\/us\/unitedhealthcare-pay-million-robocall-settlement\/\" data-type=\"post\" data-id=\"2041\">UnitedHealthcare to Pay Millions in Robocall Settlement \u2013 Are You Eligible?<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.soscip.org\/us\/trumps-sweeping-healthcare-overhaul\/\" data-type=\"post\" data-id=\"1956\">Trump\u2019s Sweeping Healthcare Overhaul: How 24 Million Americans Will Be Impacted<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.soscip.org\/us\/elon-musks-doge-force-gains-medicare-medicaid\/\" data-type=\"post\" data-id=\"2478\">Elon Musk\u2019s DOGE Task Force Gains Access to Medicare &amp; Medicaid: Unprecedented Move Raises Questions<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"financial-struggles-amplify-the-conflict\">Financial Struggles Amplify the Conflict<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">OHSU\u2019s concerns come at a critical time as the institution battles financial losses exacerbated by the COVID-19 pandemic. In the last six months of 2023, OHSU reported an operational loss of $33 million\u2014an improvement from the $69 million loss in the same period the previous year. To bridge this financial gap, OHSU is pushing for higher reimbursement rates from UnitedHealthcare, requesting a 36% price increase for services under commercial plans over two years, along with a 15% increase for Medicare Advantage plans.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">UnitedHealthcare argues that these increases would place an $88 million burden on Oregon residents and employers, raising healthcare costs unnecessarily.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"peer-to-peer-denials-a-major-pain-point\">Peer-to-Peer Denials: A Major Pain Point<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">OHSU also highlights that nearly half (48%) of all peer-to-peer denials\u2014where OHSU providers must directly appeal rejected claims to UnitedHealthcare\u2019s medical directors\u2014originate from UnitedHealthcare. This high rate of appeals adds to administrative burdens and delays in patient care, further straining provider-insurer relations.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"a-national-trend-healthcare-networks-in-turmoil\">A National Trend: Healthcare Networks in Turmoil<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The dispute between OHSU and UnitedHealthcare is not an isolated incident. In December, Aetna severed ties with Providence Health &amp; Services after failed negotiations, leaving many Portland-area patients scrambling for alternative providers. These conflicts underscore the growing tensions between healthcare providers and insurers nationwide as both struggle to balance costs and care quality.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"whats-next-for-patients\">What\u2019s Next for Patients?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">If no agreement is reached by March 31, patients covered by UnitedHealthcare may be forced to find new providers or face out-of-network charges for OHSU services. While negotiations continue, the outcome remains uncertain, leaving thousands of Oregon patients anxiously awaiting a resolution.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As healthcare costs continue to rise, disputes like this highlight the critical need for transparency, efficiency, and fair reimbursement practices to ensure that patient care remains the top priority.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Oregon Health &amp; Science University (OHSU) has issued a stark warning to 74,000 patients covered by UnitedHealthcare, stating that they may lose access to OHSU hospitals and clinics if ongoing contract negotiations fail. The existing agreement is set to expire on March 31, leaving patients in limbo as both parties struggle to reach common ground.&nbsp;<a class=\"read-more\" href=\"https:\/\/www.soscip.org\/us\/unitedhealthcare-vs-ohsu-denial-rates\/\">Continue reading<\/a><\/p>\n","protected":false},"author":1,"featured_media":2484,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2482","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/posts\/2482","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/comments?post=2482"}],"version-history":[{"count":2,"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/posts\/2482\/revisions"}],"predecessor-version":[{"id":2485,"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/posts\/2482\/revisions\/2485"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/media\/2484"}],"wp:attachment":[{"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/media?parent=2482"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/categories?post=2482"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.soscip.org\/us\/wp-json\/wp\/v2\/tags?post=2482"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}