For three months, Nampa mental health counselor Rebekah Scott was behind on her rent.
In an interview with the Idaho Capital Sun, she explained that this was because she was not receiving payment for treating the majority of her patients, who were Idaho Medicaid recipients.
She claimed that she was already kind of running on fumes as a divorced, single mother of challenged children. She battled to keep the power on, but she continued to serve patients when her pay was delayed.
She claimed to have received her first payment of $149 in October. She then claimed that Magellan of Idaho, Idaho Medicaid’s new contractor managing mental health coverage, collaborated with her to resolve billing problems that she claims were caused by the use of out-of-date billing code information.
However, she reported that more checks have now been received. There will be more soon.
She and other providers say they appreciate Magellan’s prompt, responsive efforts to address billing difficulties, despite the fact that Idaho Medicaid mental health providers have experienced delayed reimbursements since Magellan took over the $1.2 billion contract in July.
According to Laura Scuri, co-chair of the Idaho Association of Community Providers’ behavioral health subgroup and co-owner of Boise’s Access Behavioral Health Services, a lot of what we’re seeing are just strange, sporadic things that don’t pay at the moment. However, according to my business partner, who has nearly 20 years of invoicing experience, it is typical. Every time an insurance firm makes a change, things don’t work out and there are unforeseen consequences.
However, she noted that Magellan’s excellent communication was novel.
In an interview with the Sun, Scuri said, “I can send a text and get a response.” which has never occurred to me in my life.
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Since Magellan is now responsible for overseeing more facets of mental health benefits than the previous contractor, Optum, which also initially delayed payments to providers, some providers also said they anticipated challenging times under the new contract.
The new contract transition has gone smoothly, according to Juliet Charron, deputy director of Medicaid and behavioral health for the Idaho Department of Health and Welfare.
I’m not going to deny that there have been hiccups. In an interview with the Sun, she said, “And we expected some bumps.” However, she notes that health officials have concentrated on whether Magellan is promptly addressing payment difficulties with providers and whether patients are still receiving services.
According to Charron, Magellan has generally been a very excellent partner with providers.
The Idaho Capital Sun reached out to Magellan of Idaho for comment on this article, but he did not reply.
What is the contract for the Idaho Behavioral Health Plan?
Idaho’s largest state government contract is being handled by Magellan of Idaho, a member of the nationwide Medicaid managed care organization Centene. The Idaho Behavioral Health Plan has a four-year, potentially renewable contract worth $1.2 billion to administer Medicaid mental health benefits.
Optum, the final Medicaid mental health contractor in Idaho, started providing mental health services ten years ago. When Magellan took over in July, its contract expired.
While Optum’s contract required it to provide outpatient mental health treatments, such as therapy visits, Magellan’s new deal requires it to provide inpatient mental health care, such as hospitalizations.
The contract is far more extensive. Idaho Medicaid and mental Health Deputy Director Juliet Charron stated, “We are asking Magellan to manage pretty much the whole continuum of behavioral health services for the state.”
Why were payments delayed? Some believe it’s a new, expanded contract.
According to a recent Sun article, Idaho Medicaid mental health care providers anticipated payment delays even before Magellan assumed control of the contract, partly because Magellan hadn’t tested systems as quickly as some providers had planned.
According to lobbyist David Lehman of the Idaho Association of Community Providers, some providers are still figuring out how to get paid, even while others have done well under the recent transition. He claimed that a number of provider worries prior to the implementation of the new contract were legitimate.
According to Lehman, we were first concerned that Magellan needed to give providers additional guidance and training on how to use the billing systems.
CEO and President DeVere Hunt told the Sun in an interview that Rehabilitative Health Services has received prompt reimbursements from Magellan for crisis center services, even though it is a new perk in the contract. However, according to Hunt, Magellan is four months overdue on payments to his clinic for another program that is new to the contract: Early Serious Mental Illness, or EMSI, a preventive mental health program.
According to him, Magellan leadership has been quite quick to try to fix the program’s payment problems. Hunt blames growing pains for the late payments.
I don’t believe that the payment was purposefully delayed. He told the Sun that it has just been a matter of learning how modifiers are priced differently than they were with Optum or how they might be billed with other companies.
As we work to create these new procedures inside the billing systems, he stated that he believes it’s just the transitional parts.
According to Scuri, Magellan’s billing software is rather cumbersome. Since the contractor transfer, she added, a few providers had chosen not to provide behavioral health services, and two very tiny providers informed her that they had closed.
According to her, problems with medical payments are common. She added that Magellan’s contract has three times as many moving pieces as Optum’s.
There will be problems, but they will respond to them, unlike what we experienced previously (under Optum). According to Scuri, there are still problems, and they’re significant because they affect a lot of people, but they’re normal for an insurance company.
How a Nampa counselor made ends meet when her salary stagnated
Scott claims she continued to see Medicaid patients during the three months she was behind on her rent while her Magellan payments froze.
Using money from another job and money her disabled son contributed from his employment, she managed to cobble together enough to pay the rent, she added.
She claimed to have lost her car, though. She claimed that because her electricity has been cut off so frequently, her children are accustomed to it.
According to her, Scott signed up for SNAP, sometimes known as food stamps, and Medicaid.
She stated that her school loan and tax payments are postponed.
She informed the Sun that she had signed a new lease, which was for a shorter nine-month period and cost an additional $200 per month.
How to get assistance for Idaho Behavioral Health Plan-related concerns
Regarding problems with Magellan of Idaho, providers can send an email to [email protected]. The Idaho Department of Health and Welfare keeps an eye on that email line.
In an interview with the Idaho Capital Sun, Idaho Medicaid and Behavioral Health Deputy Director Juliet Charron stated that staff members follow up on all issues submitted, including those from providers, stakeholders, and participants.
Magellan has promptly assisted providers.
The Sun was informed by Lehman, a lobbyist for a provider group, that the deployment of the contract has been far more effective than it was under Optum, which initially assumed the contract ten years ago.
According to him, large suppliers with skilled billing personnel have done better under the new contract transition, especially in terms of receiving payment.
“I think they’ve struggled more for smaller providers, who don’t have the same level of resources,” Lehman said.
Lehman emphasized, however, that Magellan has made a concerted effort to address providers’ concerns. He said Magellan of Idaho s CEO David Welsh has personally taken several customer service calls.
There is still hope that things will continue to improve, and I believe that Magellan is making an effort to try and meet the concerns that providers have. But certainly, it has not been the same experience for all of the various providers, he said.
Before Magellan officially took over the contract, Charron said Magellan and Health and Welfare worked to make sure they were prepared for the transition and they had to prove that to federal regulators at the Centers for Medicare and Medicaid.
From the state s perspective, we saw that Magellan was very prepared, she said.
I ve been through a number of managed care rollouts personally in my professional career, and there are always those unforeseen things that can happen, Charron said. I think what matters is how quickly the plan and the department can resolve it and get it fixed so that it s not impacting participant services, and care, and provider experience, provider reimbursement.
Checks are in the mail
Until September, Magellan sent providers payments by mailed checks in response to a hack into a national payment system. Providers say they didn t receive some of those checks.
Charron says she was on some emails from providers complaining about missing checks. And she said she saw Magellan leadership offer to overnight mail the checks.
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Before Magellan transitioned to electronic payments, some providers got prepaid debit cards as payment. When Magellan learned that some providers were charged extra fees to access the cards, Charron said the company fixed it.
Magellan is a national entity, but we wanted them to be Idaho-based understand what it means to be an Idaho provider in (a) rural community or in our more urban areas, to understand the geography of our state and how people access care, or navigate care. And I feel like they ve really taken that seriously, Charron told the Sun.
Since Scott s first payment in October, she said she s received more from Magellan, but it s been a few hundred dollars at most each time. Over four months into Idaho s contract with Magellan, Scott said she s still short thousands of dollars in payments for patients she s treated.
As the only employee in her clinic in Nampa, she handles billing and treats patients, she told the Sun.
It was already hard enough. And then to have everything just sort of, all of my income, just dry up in July was really brutal, Scott told the Sun. But Magellan has been very kind, and very helpful. I m really grateful for that.
One evening, she said a Magellan billing staffer helped her realize that her modifiers on billing claims needed to be different one of several billing issues she s ran into.
In an interview three days before Thanksgiving, she said she was told that almost $5,000 in direct deposits were on the way. Some were set to arrive Wednesday, she told the Sun on Tuesday afternoon.
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