Men­tal health ser­vices at risk in Min­nesota con­tract dis­pute

Modern Healthcare - - REGIONAL NEWS - —An­dis Robeznieks

Hun­dreds of chil­dren in Min­nesota could soon have a harder time get­ting healthcare be­cause of a con­tract dis­pute be­tween a payer and a provider.

Prairie Care, a Brook­lyn Park-based op­er­a­tor of men­tal health hos­pi­tals and clin­ics, an­nounced that on Oct. 20 it will sever ties with Med­ica, a not-for­profit in­sur­ance com­pany that serves about 1.5 mil­lion cus­tomers in Min­nesota and sur­round­ing states. Prairie Care claims the in­surer re­stricts when chil­dren can get care.

Med­ica, how­ever, claims that pa­tients, on av­er­age, stay at Prairie Care fa­cil­i­ties three days longer than at other hos­pi­tals and the cost to care for them is 150% higher. Prairie Care is ask­ing for a rate in­crease in its next con­tract.

Med­ica’s be­hav­ioral healthcare net­work is main­tained and man­aged by Op­tum, a con­sult­ing and tech­nol­ogy ser­vices arm of in­sur­ance gi­ant United-Health Group.

Prairie Care CEO Dr. Joel Ober­star was quoted in the an­nounce­ment as say­ing that only 20% of the sys­tem’s pa­tient pop­u­la­tion was cov­ered by Med­ica, but its uti­liza­tion-re­view staff spent 80% of its time fight­ing to get au­tho­riza­tion for crit­i­cal psy­chi­atric care.

Med­ica spokesman Larry Bussey says Prairie Care’s pa­tients are ex­pen­sive to cover and that the health sys­tem is ask­ing for rate in­creases of “200% to 300%.”

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