Thread regarding Molina Healthcare Inc. layoffs

Utahns who get their Medicaid coverage through Molina Healthcare will no longer be insured

https://www.ksl.com/?sid=46326190&nid=757&title=utahns-with-medicaid-chip-through-molina-to-lose-coverage-in-u-health-system

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."

by | Post ID: @Tk4iTkd
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6 replies (most recent on top)

Is it just me, or is this insane? This just seems so crazy. Paying providers with ISF checks? Loading contacts improperly in the claims payment system causing lack of payment or slow payment? You call this, "significant administrative issues with Molina that have not been fully resolved"? Really?

About a decade ago I worked for a small health plan and many of the folks working there had previously worked at Molina. The word on Molina was that it was a bad place to work. That it was a mess, ghetto, etc. I suppose that was all true!

I can't believe anyone works at Molina and feels proud or thinks their jobs are secure. What kind of kool aide are they serving around there? Yikes.

by | Post ID: @Tk4iTkd-6tzq

I remember when those checks bounced at modena. Talking points were sent out and it was a hot ghetto mess. Oh and get this, most of those people are working there today. Incompitence at its finest.

by | Post ID: @Tk4iTkd-3yan

I worked as a contributor to this project and it was an executive at MHI who made the decision to part away.

I don't know what the relationship was before but I think there were issues with Medicaid (no profit).

Molina knew that cutting the relationship would affect the membership volume because it was the U of U network that was making it there. No one really cares is how I felt.

by | Post ID: @Tk4iTkd-1usd

I remember a couple of years ago when I was with the Ohio plan, Molina checks sent to providers were 'bouncing' for insufficient funds. This happened for a 2 week period. Try explaining that to providers!

by | Post ID: @Tk4iTkd-wsc

Whomever at the health plan is responsible for this gross negligence needs to be fired if they weren't already. What a load of crap. Way to go Utah plan! Your leadership is astounding!

by | Post ID: @Tk4iTkd-cws

Same kind of thing happened in New Mexico with Davita. Molina takes forever to pay claims and are tight opening the wallet. Davita got tired of providing services and not being paid.

by | Post ID: @Tk4iTkd-hiy

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