A Brooklyn Park-based operator of mental health hospitals and clinics says it will drop out of Medica's provider network, claiming the Minnetonka-based health insurer has overly restrictive policies about when children and teens can get care.
Medica counters that PrairieCare's costs are out of line with other hospitals. It also keeps patients in the hospital an average three days longer than other providers, Medica claims.
If the contract dispute is not resolved, PrairieCare would stop being a provider of inpatient and partial-inpatient services for Medica patients on Oct. 20.
Last year, about 360 kids with Medica coverage obtained that level of care at PrairieCare, said Todd Archbold, chief development officer at PrairieCare.
Mental health advocates are concerned about the possible impact for kids, particularly those covered by the state's Medicaid program for low-income Minnesotans.
"You really want insurance plans to be covering as many providers as possible, because we have shortages," said Sue Abderholden, executive director of the National Alliance of Mental Illness in Minnesota, adding that she could not comment on the arguments put forth by both sides.
It's not uncommon for contract disputes between health insurers and health care providers to become public as deadlines approach. A contract dispute between Medica and Children's Hospitals & Clinics of Minnesota last year, and a 2013 dispute between Blue Cross and Blue Shield of Minnesota and Regions Hospital, ultimately were settled before patients were affected.
In a Sept. 9 letter to patients, PrairieCare officials said there was "a profound difference of position" between the organizations about Medica's standards for reviewing the use of patient services. Without a contract, Medica patients might have to pay more for PrairieCare services, according to the letter.
PrairieCare says Medica has created unreasonable barriers to care, and has pushed PrairieCare's treatment team to discharge patients sooner than doctors feel is medically appropriate.
"It's our opinion that their actions are neither in the best interest of their members who need intensive psychiatric services nor consistent with 'in network' relationships we have with other Minnesota insurers," said Dr. Ryan Williams, PrairieCare's chief medical officer, in a statement.
Greg Bury, a Medica spokesman, said PrairieCare has been an outlier in terms of the cost for services provided, yet is pushing for large payment increases in its next contract. PrairieCare makes more extensive use of partial-hospitalization programs, Bury said, rather than facilitate transitions into community-based services.
Bury noted that PrairieCare is a for-profit provider, "unlike most other providers in Minnesota," he said.
"This is a typical negotiation between a health plan and a provider," Bury said.