Medicaid payments withheld by RMHP threaten Western Slope mental health provider

The new year is off to a rough start for one local mental health care provider due to ongoing Medicaid billing issues with Rocky Mountain Health Plans.

Joel Watts, founder and CEO of Integrated Insight Community Care, is fighting for his company’s life after months of Medicaid reimbursement delays from insurance provider Rocky Mountain Health Plans.

“Rocky Mountain doesn’t pay us for services, which means we have a lot of people who are about to lose mental and behavioral health and medical care. We have people who are on the verge of homelessness simply because Rocky Mountain refuses to pay the money they think they owe us,” Watts said.

Watts says the problem began after UnitedHealthcare took over the for-profit insurance provider, creating “configuration and credential issues” with Rocky Mountain Health Plans, which in turn had a negative impact on the health care provider located in Delta.

“We told them this puts Integrated at risk, which means it puts 107 employees at risk and puts about 2,000 people in our service area that we serve every day,” Watts said. “Many of them with severe psychiatric issues, many of them with medical issues, fourteen people in our transitional housing are either going to go back to prison or the street (putting them) at risk.” And the only thing we get is “we will put a ticket”.

Due to billing configuration issues, Rocky Mountain Health Plans ordered Watts to hold claims for more than six months, resulting in a significant backlog of accepted but unpaid claims.

In addition to the unpaid claims, the insurance provider accused Integrated of accepting payments without providing services during the nine-month billing hiatus, claiming Integrated owed the insurance provider $1.7 million.

Watts says the claim is simply not true, noting that during the billing hold, Integrated added psych and medicine to its clinics with the encouragement of Rocky Mountain Health Plans.

He says the integrated clinics are also continuing to provide mental health services, waiting and hoping that UnitedHealthcare will fix their problems before vital health services on the Western Slope are permanently terminated.

The two organizations have been working to find a solution since August, but Watts says communication with Rocky Mountain Healthcare Plans has all but ceased, leaving the rural health care provider with cash flow problems, threatening the jobs of loyal employees and thousands of customers in need.

“This is to the detriment of the Western Slope. As you know, before Integrated came here there was a huge gap in services. You had three CMHCs in the area that weren’t doing what we were doing. It would be sad to lose the service we provide, especially at the moment,” Watts said.

In an emailed statement, Rocky Mountain Health Plans said the claims made by Integrated were inaccurate. They say they have continued to engage with Integrated while fulfilling their contract, including working with the company through its bankruptcy filing.

Watts says the Chapter 11 debt reorganization is a direct result of Rocky Mountain Health Plans not honoring its verbal agreement to help Integrated establish primary care, as well as ongoing problems with its value-based contract with the insurer.

“We showed up and throughout the process we were in full communication with Rocky because we wanted to continue to serve the community, that’s our goal. No help offered at any point, keeps refusing, no communication. And we know that assistance has been provided to other providers,” Watts said.

Integrated Insight Community Care will continue, at least for now, to maintain its statewide telehealth services while providing virtual services at numerous in-person clinics in Western Colorado.

Rocky Mountain Health Plans says it is committed to maintaining access to care through a network of available providers.

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