MINNEAPOLIS -
Sept. 9, 2015 -
PRLog -- Without a break in the existing impasse, effective October 20th, 2015, PrairieCare will no longer be an in-network provider with Medica/Optum for hospital-based psychiatric services. PrairieCare is Minnesota’s largest provider of intensive child and adolescent psychiatric services, providing care to hundreds of Medica/Optum members annually. PrairieCare leadership believes that Medica/Optum has burdened members and clinicians with unreasonable barriers to accessing/receiving care and has made no meaningful efforts to resolve substantive concerns raised regarding unreasonable utilization management policies.
With increasing frequency, Medica/Optum reviewers have pushed PrairieCare’
s treatment team to discharge patients sooner than the treating Child & Adolescent Psychiatrist feels is medically appropriate. According to Dr. Joel Oberstar, PrairieCare’
s Chief Executive Officer, “Although about 20% of our patients have Medica/Optum insurance, our utilization review staff spends more than 80% of their time struggling with Medica/Optum utilization management staff, fighting to get authorization for critical psychiatric care. In our opinion, their utilization management approach is well outside the community standard and creates a real barrier to care.” PrairieCare has been trying to work through disputes with Medica/Optum since fall of 2014 with no progress. “Our relationship with Medica/Optum has become untenable, and it’s our opinion that their actions are neither in the best interest of their members who need intensive psychiatric services nor consistent with ‘in network’ relationships we have with other Minnesota insurers,” says Dr. Ryan Williams, PrairieCare’
s Chief Medical Officer.
PrairieCare is notifying its current/recent patients with Medica/Optum insurance plans that their benefits will no longer cover services at PrairieCare beginning October 20th, 2015. Members can still receive care at PrairieCare, but likely at higher costs to them.
For more information, please call Todd Archbold 952-836-8480.
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