State medicaid has no idea what's going on

[nexus73]

We are reducing capacity at our small hospital affiliated outpatient clinic due to providers leaving. Hospital admin talked with Medicaid because we're stuck sending many patients back to PCPs. Medicaid gave the hospital a list of all the Medicaid psychiatrists/nps in the region....

Half the list was social workers or psychologists.
45% were inpatient only doctors, retired doctors, people who've moved away, or locums who previously covered inpatient only but are now gone.
The other 5% were the remaining providers at our clinic who are booked solid and can't take more patients which is why providers leaving is leading to patients discharging from clinic to PCPs.
Not on the list were 4 np's at the local FQHC who do accept medicaid but are booked out 6 months.

So...I don't know what to say other than I am losing what little hope I had left

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[trophyhusband]

We are reducing capacity at our small hospital affiliated outpatient clinic due to providers leaving. Hospital admin talked with Medicaid because we're stuck sending many patients back to PCPs. Medicaid gave the hospital a list of all the Medicaid psychiatrists/nps in the region....

Half the list was social workers or psychologists.
45% were inpatient only doctors, retired doctors, people who've moved away, or locums who previously covered inpatient only but are now gone.
The other 5% were the remaining providers at our clinic who are booked solid and can't take more patients which is why providers leaving is leading to patients discharging from clinic to PCPs.
Not on the list were 4 np's at the local FQHC who do accept medicaid but are booked out 6 months.

So...I don't know what to say other than I am losing what little hope I had left

That's not just Medicaid. Half the commercial insurers in our area still have my wife listed as in network for an inpatient job she hasn't worked at for almost 4 years. Big local insurance company just contacted the CMHC she last worked part time at over two years ago to re-credential her.

Feel like there would be a much bigger uproar if these provider lists were anything resembling accurate... which is probably why they're not updated regularly/correctly.

 

[calvnandhobbs68]

Yeah this is kinda par for the course for insurance company “network” lists. There’s been media about reporters calling doctors on these lists to find out significant portions are either not actually on the panel or retired or dead or something.

 

[DD214_DOC]

Nobody has any idea what's going on. I still show up with a clinical psychologist taxonomy a year into my current position. This was carried over from my time in the same system while in the active military, as I traced its origin back to my initial privileges at my training institution -- who had entered me into their credentialing system as a clinical psychologist.

This is the DoD, so it's all make-believe reimbursement and money anyways and doesn't really matter but it does appear that I'm the right, "provider", type where it matters.

My two psychologist friends absolutely love it, though. They remind me of this often.

On a related note, I'm listed in PECOS incorrectly as well and still falling under a previous employer I was onboarding with but ended up withdrawing from before the contract start date. Evidently, we cannot make changes to our profiles in PECOS and related ourselves and rely on some third-party entity to do all this. I cannot get anyone from this place on the phone with me and usually get blocked and told it must be the, "representative", or trusted agent or whatever they call it -- who is still listed as someone from the employer I never started with.

Ultimately, I just said, "**** it", and moved on with life. It doesn't seem to cause any issues I'm aware of.

 

[PikminOC]

Ghost networks are purposely done. Then they can say there at nine psychiatrist in the area who could have done the work in network. But they aren't in network. I just had denial from uhc that said this.

 

[whopper]

Here's a very educational video on Medicaid.

 

[nexus73]

I think the irony was the manager being proactive reaching out to Medicaid with concerns about no psychiatrists, and then Medicaid returning triumphant with this list. And half the people are social workers.

 

[Candidate2017]

So...I don't know what to say other than I am losing what little hope I had left

Given Medicaid reimburses outpatient physician services less than what a quarter ounce of mediocre weed costs, I find it remarkable you had any hope in the first place.

 

[nexus73]

Given Medicaid reimburses outpatient physician services less than what a quarter ounce of mediocre weed costs, I find it remarkable you had any hope in the first place.

Just sitting here getting repeatedly shocked like some helpless dog.

 

[hallowmann]

Given Medicaid reimburses outpatient physician services less than what a quarter ounce of mediocre weed costs, I find it remarkable you had any hope in the first place.

Man, how is it that you so consistently make me love and hate your posts simultaneously