Recently I attended yet another meeting regarding Heritage Health and the significant issues that continue to plague the roll out to the integrated managed care contracts that were put in place on January 1st. I was truly dumbfounded that seven months in to this process we are still hearing concerns from providers of claims not being processed, pages of claims getting lost during certain submission formats, tens of thousands of dollars still being owed to providers (for more than 60 days), the lack of knowledge by the companies to handle carry over authorizations, basic preventative products being denied, poor customer relations and communications, and many more concerns. How can companies the size and stature of these three managed care companies get away with this? How is Nebraska’s state government who holds this contract not demanding timely resolution? Or how has it got to this point in the first place?
My hope is that after this meeting, and once again hearing the grave concerns of providers, action will be taken immediately. To have a non-profit behavioral health provider stand up and say they are still owed tens of thousands of dollars for services already provided highlights just one major issue with the current status of these contracts. These providers are unable to carry both the financial and administrative burden that has been created by these shortcomings. It simply isn’t fair and wouldn’t be allowed in other areas of business. To be fair, not all of the managed care companies are struggling with all of the issues raised, and one company seems to be doing overwhelmingly better than the other two through the transition, but there is still much work to be done.
To sit at a meeting such as this and not have answers is unacceptable. To simply say, “Let me give you my card and we can follow up on this matter,” isn’t enough. We need swift resolution…perhaps remedial fines or interest on back payments should be enforced and paid to impacted providers based on what is allowed by the contracts.
My final point is that through all of these discussions, we cannot lose sight of the true impact these mistakes and unpreparedness have caused on not only the providers, but most importantly the vulnerable people they serve. These individuals were brought up a handful of times during the meeting, but they should be at the forefront of every discussion. They should be the driving force to correct these errors. If providers have to cut services or worse yet, close their doors because of lack of or delayed reimbursement by these managed care companies, our community members, our neighbors, our family members, are the ones bearing the burden. That is unacceptable and should not be ok with our state government. My hope is that we get this right. And get it right quickly.
Julia Hebenstreit, Executive Director of The Kim Foundation
Julia Hebenstreit is the Executive Director of The Kim Foundation. She received her J.D. from Creighton University in 2005, and her BS in Journalism from the University of Nebraska Omaha in 2002. She has been with The Kim Foundation since 2011, and prior to that worked for local non-profits doing development, strategic planning, communications and advancement. She has a passion for helping people and improving lives, and serves on the Executive Committee for Nebraska Association of Behavioral Health Organizations, as the 2015 Hill Day State Captain for the state of Nebraska, and as an active member of the Nebraska Suicide Prevention Coalition, the Early Childhood Mental Health Coalition, BHECN Advisory Committee, RESPECT Advisory Board, Connections Advisory Board and the Project Propel Planning Group.