A manager of behavioral health and substance-use disorder services for Humana and CareSource warned its providers on Thursday that Medicaid patients’ claims had erroneously been denied for lack of coverage because of more confusion related to the state’s Kentucky HEALTH program.
The warning from Beacon Health Options comes on the heels of reports that children and other traditional Medicaid patients had been denied dental and vision coverage after a federal judge blocked the Bevin administration’s 1115 waiver program from being implemented in late June — even though the administration had only intended to end such benefits for nearly 400,000 recipients in the expanded Medicaid population.
The Kentucky Cabinet for Health and Family Services blamed the confusion over dental and vision benefits on technological issues caused by the abrupt halt to the program that was set to launch two days after the judge’s ruling, but reversed course last week and announced its intention to restore such benefits to all Medicaid recipients, pending the Kentucky HEALTH program’s return.
However, the message from Beacon Health Options to providers in the Humana and CareSource network on Thursday indicated that more confusion remains in the behavioral health area, which includes treatment for drug addiction as the state battles the opioid epidemic.
“Please be aware that Beacon is currently experiencing issues with updating member eligibility information due to the changes related to KY HEALTH benefits and is working closely with Humana — CareSource to rectify,” stated the bulletin. “Please use the KyHealth Net Portal to confirm member eligibility prior to declining service to any members.”
The message from Beacon added that “this eligibility issue has caused claims to be denied erroneously for no coverage,” but they would work to reprocess any claims that were denied despite the member being eligible.
Angela M. Koch, the education and outreach director of health care advocacy nonprofit Kentucky Voices for Health, told Insider Louisville that “it appears there is even more confusion among providers, consumers, and MCOs than originally thought.”
“The inability of providers to determine eligibility could have disastrous effects for those seeking substance use treatment or behavioral health services,” added Koch.
Sheila Schuster, the executive director of the Kentucky Mental Health Coalition, told Insider that this latest occurrence of denials of claims and coverage “seems to fit with this overall zeitgeist of confusion,” which could end up hurting both consumers and providers.
Spokespersons for the cabinet and Gov. Bevin did not return an email requesting comment on the matter, nor did those from Humana and Beacon.
Reposted from https://insiderlouisville.com/health/kentucky-health-glitch-now-causing-claims-denials-for-substance-abuse-treatment/