The new year is getting off to a rocky start for one local mental health care provider due to ongoing Medicaid billing issues with Rocky Mountain Health Plans.
Joel Watts, founder and CEO of Integrated Insight Community Care, has been battling for his company's life after months of delays in Medicaid reimbursements from insurance provider Rocky Mountain Health Plans.
“Rocky Mountain is not paying us for services, which means we have a lot of people who are about to lose some mental and behavioral health and medical care. We have people who are about to be homeless simply because Rocky Mountain refuses to pay the money that they said they owe us,” Watts said.
Watts says the problem began after UnitedHealthcare took over the non-profit insurance provider creating “configuration and credentialing issues” with Rocky Mountain Health Plans, which in turn have had a negative impact on the health care provider located in Delta.
“We have told them that this is putting Integrated at jeopardy, which means that it's putting 107 employees at jeopardy, and it's putting about 2,000 people in our service area that we serve every day,” said Watts. “ Many of them with severe psychiatric issues, many of them with medical issues, fourteen people in our transitional housing will either go back to jail or the streets (putting them) at risk. And the only thing we get is "We’ll put a ticket in.”
Due to billing configuration problems, Rocky Mountain Health Plans directed Watts to withhold claims for over six months, resulting in a substantial backlog of accepted but unpaid claims.
In addition to the unpaid claims, the insurance provider accused Integrated of taking payments without providing services during the nine-month billing pause, claiming Integrated owed the insurance provider $1.7 million dollars.
Watts says the claim is simply not true, noting that during the billing hold, Integrated added psyche and medical at their clinics at the encouragement of Rocky Mountain Health Plans.
He says Integrated clinics also continued to provide mental health care services waiting and hoping that UnitedHealthcare would fix their issues before vital health care services on the Western Slope were discontinued permanently.
The two entities had been working to find a solution since August. However, Watts says communication with Rocky Mountain Healthcare Plans has all but ceased leaving the rural health care provider with cash flow issues threatening the jobs of loyal employees and thousands of clients in need.
“This is a detriment to the Western Slope. As you know, before Integrated got here, there was a huge gap in services. You had three CMHCs in the area that were not doing what we were doing. It would be sad to lose the service that we provide, especially right now,” Watts said.
In an email statement, Rocky Mountain Health Plans says the assertions made by Integrated are inaccurate. They say they’ve continued to engage with Integrated while fulfilling their contract, including working with the company through its bankruptcy filing.
Watts says the Chapter 11 debt reorganization was a direct result of Rocky Mountain Health Plans not honoring their verbal agreement to help Integrated establish primary care, as well as the ongoing issues related to its value-based contract with the insurer.
“We emerged and, throughout the entire process, fully communicated with Rocky because we wanted to continue to serve the community. That’s our purpose. At no point was help offered, continues to be denied, communication is shut down. And we do know that help has been provided to other providers,” said Watts.
Integrated Insight Community Care will continue, at least for now, to keep its statewide telehealth services going while providing virtual services at numerous in-person clinics throughout Western Colorado.
Rocky Mountain Health Plans say they are committed to sustaining access to care through a network of available providers.
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