Saint Mary's Health Network to Discontinue Some Medicaid Plans - KTVN Channel 2 - Reno Tahoe Sparks News, Weather, Video

Saint Mary's Health Network to Discontinue Some Medicaid Plans

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Letter Sent to Affected Patients Letter Sent to Affected Patients

For the second time in less than six months, Saint Mary's Health Network is discontinuing some Medicaid plans. 

Saint Mary's says in July of this year, through the legal process, both Health Plan of Nevada and Amerigroup agreed to uphold their contracts with Saint Mary’s. This process resulted in a firm 90-day window of time where both parties had to make good on their terms of their contracts.

Since that time, Amerigroup has made good and is actively working with us to better support Medicaid patients.

Saint Mary's says unfortunately, this is not the case with HPN. They say despite this new agreement to uphold their contract within the 90-day window, they have not done so, and it has been specifically outlined that the contract would be terminated if this did not happen.

To read our previous stories - click here: http://bit.ly/299DGCs and here http://bit.ly/29WzDq7

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From Saint Mary's Health Network:

"On September 9, 2016, Saint Mary’s Health Network informed Health Plan of Nevada that it is in material default of its contract with Saint Mary’s and that absent a cure of the defaults by October 9, 2016, Saint Mary’s will discontinue its provider relationship with Health Plan of Nevada (HPN). No cure has been effected and therefore absent further notice from Saint Mary’s that a cure has been effected, on and after October 9, 2016 Saint Mary’s Medical Group will no longer accept HPN Medicaid. On and after October 19, 2016 Saint Mary’s Regional Medical Center will no longer accept HPN Medicaid, Senior Dimensions or HPN commercial products. 

This termination is a result of contract terms that were not upheld by HPN, which continues to engage in a deliberate and regular practice of denying payment and/or underpaying Saint Mary’s for medical services provided to its members. 
 
Saint Mary’s provides the highest quality care to HPN members and expected and hoped that HPN would reciprocate by honoring its responsibility to fairly and timely compensate Saint Mary’s for care provided,  and respecting the mutually agreed upon contract terms. 
 
As a trusted health care provider, we will work with HPN members receiving long-term care or treatments beyond the termination date so they are cared for appropriately. During this transition, HPN holds a responsibility to transfer its members to other available providers. Saint Mary’s will ensure HPN patients will receive care until they are successfully transferred to an accepted provider within HPN’s network.  
 
Saint Mary’s continues to accept patients using a fee-for-service Medicaid product as well as Medicaid Amerigroup.  Per EMTALA regulations, patients presenting to Saint Mary’s Emergency Room for emergent health care needs will receive care regardless of their health insurance provider. 
 
We believe there must be a larger conversation involving MCO’s and providers to ensure that our entire community receives the care it deserves. We remain willing to engage in continued conversations with insurance providers and lawmakers to develop a workable, long-term solution."

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From Health Plan of Nevada: 

"Saint Mary’s is again placing Health Plan of Nevada’s Medicare, Medicaid and commercial members’ health at risk. As of September 23, Saint Mary’s is refusing to treat or schedule care for our members and is sending letters with misleading and false information directly to our members. 

Health Plan of Nevada continues to try to work with Saint Mary’s despite Saint Mary’s refusal to provide Health Plan of Nevada with any information regarding their allegations. We expect Saint Mary’s to continue to fulfill its contractual and legal obligations to care for our 57,000 northern Nevada members and are committed to providing our members access to quality care despite Saint Mary’s illegal conduct.”

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After our report, Health Plan of Nevada sent us this statement: 

Saint Mary’s has questioned fewer than 100 claims filed with Health Plan of Nevada since June 1. That is less than 2 percent of the total claims filed, and they have filed an appeal on just four claims.

Additionally, Saint Mary’s has only provided HPN with required medical records for nine of the questioned claims. HPN owes a responsibility to its members and Nevada taxpayers to review the records of all medical claims to ensure proper payment.

Rather than follow the terms of its contract or Nevada Medicaid regulations, Saint Mary's is trying to find reasons to exit its obligation to take care of Northern Nevada's vulnerable and at risk Medicaid population.

HPN has worked alongside local care providers for 30 years to keep Nevadan’s health care costs low, yet Saint Mary’s new ownership is instead focused on raising the cost of care and sending misleading and false information to members about their health coverage. 

The state of Nevada has entrusted Health Plan of Nevada to responsibly manage health care for its Medicaid members. In northern Nevada more than 37,000 Medicaid members, and another 20,000 Medicare and commercial members, have chosen HPN for access to affordable, quality health care. We will continue to deliver upon this promise to the state and the people we serve.

Health Plan of Nevada has taken legal action in this case. See the two documents below. 

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