At the end of April we were notified by a patient that they had received a denial for services performed at our office due to being a “Non Participating Provider for Healthplex”. We have been a medicaid managed care/ Healthplex provider since the office opened in 2013. Learning this information we immediately contacted provider relations at HP to figure out what was going on. We were told by HP that during a merger between HP and United Health Care (UHC) our credentialing status had been terminated due to UHC electronic system not being compatible with HP. This error essentially erased us from the system as being a participating provider for HP, causing our claims to be denied for payment. We were contacted by provider relations and were told the issue would be corrected within 10 days. Any denied claims during this time would be reprocessed for payment and we should continue seeing patients as usual.
It has now been over 1 month since this issue was brought to UHC/HP attention and we were notified yesterday that as of now they are unable to give us a time frame for correction in this matter as the issue is “drastically more involved then they first thought”. Essentially we have worked for free for over a month now and have yet to see any financial reimbursement for the patients we have continued to treat.
With this being said we are saddened to have to announce until the credentialing issue is corrected we can no longer take on the financial responsibility of continuing to see HP patients without payment. Healthplex families are a large number of our patient base and continuing to fully staff the office and proceed with our payroll expenses with 50% of our reimbursements coming in is not viable.
At this point we have no time frame or estimated date for the correction. We are going to take things week by week and hope we receive word from UHC/HP within the next month. As we receive news we will keep all of our HP families updated. Until then we suggest you contact HP directly with any concerns or grievances. We will continue to see HP patients for presently scheduled treatment and emergency based appointments only. Any routine appointments currently scheduled will be canceled for the time being.
We sincerely apologize for this announcment and cannot explain to you the level of disappointment and frustration writing this is causing us all at Seven Seas. Please bare with us, we are doing everything we can to rectify this unwarranted situation and we appreciate your understanding and patience.