SALT LAKE CITY — Beginning Sept. 1, Utahns who get their Medicaid coverage through Molina Healthcare will no longer be insured for nonemergency services they receive through the University of Utah Health system, with few exceptions.
Medicare recipients who are enrolled through Molina Medicare Options Plus will also lose their coverage for services provided by the academic hospital and clinic system. However, that change will not affect those who get coverage through Molina's Health Advantage or Healthy Advantage Plus plans.
Enrollees in the Children's Health Insurance Program will likewise lose coverage for services, though they and the others affected will be able to "continue to (be insured) for pediatric subspecialty services," said Richard Dow, director of managed care contracting for University of Utah Health.
Dow cited recent "significant administrative issues with Molina that have not been fully resolved" as the reason for ending University of Utah Health's relationship with some of the carrier's programs. Despite renegotiating its contract with Molina in 2016 to address those concerns, he said, "the operational challenges continued."
"Essentially, they weren't loading our providers appropriately in their claims systems," Dow said. "We had significant claims denials and slow claims processing turnaround times to the point that we have significant financial issues with Molina claims."
Asked for a response to University of Utah Health's decision and its reasoning behind it, Molina issued a statement saying it was "deeply disappointed" but busy making other arrangements for its enrollees.
"Although we are deeply disappointed with the University of Utah’s decision to end our relationship for those lines of business, our members can continue to receive high-quality care from one of our many in-network provider partners across the state, which includes 37 hospitals," among them Primary Children's Hospital, St. Mark's Hospital and Jordan Valley Medical Center, the statement said.
"Our top priority during this time is to ensure that our members do not experience a disruption in care, which is why we have teams in place to help members experience a smooth transition to other in-network providers."