Why OHSU Negotiates Health Insurance Contracts
Protecting your access to high-quality, leading-edge care
As the state’s academic health center, OHSU works to improve the health of all Oregonians. That includes helping patients get care from the exceptional doctors and medical experts in our health system.
What are health insurance contracts?
To provide you with care and services, OHSU creates agreements with health insurance companies. These agreements, or contracts, determine what is covered under your plan. They say how much insurers will pay for our services, like doctor visits, surgeries or telehealth.
It’s normal to review and update these contracts routinely through contract negotiations. We work hard to negotiate fair contracts with insurance companies. Without fair agreements, we can’t hire top doctors and nurses, keep up with rising costs and deliver the care you expect and deserve. Usually, negotiations go smoothly, but sometimes it’s hard for both sides to agree.
If a health insurance contract ends
When a contract deadline is nearing, you may hear terms like “contract termination” or “contract expiration.” Both mean that without a contract in place, our health system will no longer be in the insurance company’s network.
If the contract with your insurance plan isn’t renewed, then you won't be able to get care at OHSU for most medical needs. No matter what happens, we are committed to helping you find the care you need.
Our promise to you
We understand that news about insurance changes can feel confusing or stressful. But please know:
- Negotiations are a normal part of how health care works.
- We are here to help you understand your options.
- Most of all, we are committed to protecting your access to care.
Actions you can take to continue care
If our health system may be or has been removed from your health plan’s network, you have options.
- Transfer your care to another doctor who is covered by your plan.
- Ask your insurer about continuity of care with our health system if:
- You are in the middle of lifesaving treatment at our health system.
- Our health system is the only resource in the region for your rare health condition.
- Medicare Advantage members can review and choose plans during enrollment periods.
- Some employers offer more than one plan. Ask your HR contact about your options.
- Schedule appointments so you get care before the contract ends.
- Check that your insurance information is current in MyChart.
Common questions about health insurance contract changes
What happens if my insurance plan stops covering care at OHSU? Can I still see my providers?
Unfortunately, most people will need to change their care to another doctor covered by the insurance plan. Your insurance company can tell you which doctors and hospitals are in your plan. Call the number on the back of your insurance card.
What if I’m pregnant, in the middle of cancer treatment or have recently had surgery and the contract ends?
You can ask your insurer to give temporary approval to finish care, known as a "continuity of care" request. Contact your insurer to ask. It can take a few weeks to process, so it is OK to ask before the contract deadline.
What if my treatment isn’t offered anywhere else?
You can ask your insurance to request a special agreement for you with our health system. They’ll let you know what is possible.
How will I know if the contract is renewed?
You will get a letter from your insurance company. You can also check this website for updates.
What other insurance plans do you accept?
We participate in a wide range of insurance plans. Visit the billing and insurance page for more information.
Before scheduling an appointment
- Check your network. If you have health insurance, call your company to find out if the OHSU Health location or provider you plan to visit is part of your network.
- Ask what you will pay. Your insurance company can tell you what your costs are likely to be.
Can I pay out of my own pocket to keep seeing my provider at OHSU?
If you have active insurance coverage and in-network options for the same services, we recommend you use these benefits.
If you still choose to come to OHSU for care, you can pay without billing your insurance, also known as “self-pay.” Financial assistance will not apply. Please know that Medicare Advantage plans do not allow this for Medicare-covered services.
Self-pay is accepted for elective procedures, like genetic testing or cosmetic surgery, not covered by your plan. Always call first to check.
Can I use my out-of-network benefits to keep seeing my OHSU provider?
While some insurance plans do offer out-of-network coverage, our health system generally does not accept those benefits when in-network options are available. That’s because using out-of-network benefits can lead to unexpected and often overwhelming costs for patients.
Without a contract in place, we can’t provide reliable cost estimates before care. That means you could receive a large bill to pay. We believe that it is not in the best interest of our patients. There are also important federal rules—especially with Medicare Advantage plans—that limit our ability to accept out-of-network coverage. And for some plans, out-of-network payments don’t cover the basic cost of care, which can place a burden on the health system and take resources away from patient care.
However, for all services only available at OHSU within the state or region, we will make every attempt to secure insurer approval for care.
Can I go to your emergency room?
Yes. In an emergency, always go to the nearest hospital. Emergency care is covered by law, no matter what insurance you have.
How do I transfer my medical records?
You can use your MyChart account or fill out a records release form at OHSU records request.
How do I update my insurance information with the health system?
You can update your insurance information with our health system either online or by phone.
- Talk to a person for help updating your insurance
- OHSU: 503-494-8505
- Use MyChart:
- Have your insurance card handy.
- Log into MyChart.
- From the Menu on the left, scroll down to Insurance Summary.
Health insurance terms and definitions
Network
The group of doctors, hospitals and clinics that your insurance company works with.
- In-network: Doctors, hospitals or clinics that have a contract with your insurance company. You usually pay less when you use them.
- Out-of-network: Doctors, hospitals or clinics not contracted with your insurance company. You may have to pay more or the full cost to see them.
Continuity of care
A special request to your insurance company asking to keep seeing your current provider, even if they are out-of-network—especially if you’re in the middle of treatment. If approved by your insurer, the exception is limited to specific dates or the completion of treatment, whichever is shorter.
Single case agreement
A one-time deal between your provider and insurance company to cover the care you need, even if the provider is out-of-network.
Employer-provided insurance
Health insurance you get through your job, your spouse’s job or your parents' jobs. Your employer chooses the plan options.
Medicare Advantage
A type of Medicare plan from a private insurance company. It often includes extra benefits but has its own network of doctors.
Self-pay (or out-of-pocket)
When you pay for your care yourself, without using insurance.
Prior authorization
Approval from your insurance company before getting certain tests, treatments or medicines. Without it, insurance may not pay.
Elective care
Services that are not covered by insurance, often treatments like genetic testing and cosmetic surgery.