Insurance provider dropped for hospital walk-in, primary clinics

WhidbeyHealth will no longer accept Amerigroup Washington insurance at some clinics as of July 1.

WhidbeyHealth will no longer accept Amerigroup Washington insurance at its primary care clinics or walk-in clinics as of July 1, the hospital district announced.

Amerigroup is one of several options under Washington Apple Health, which is the state’s implementation of Medicaid. It will still be accepted at the hospital, the emergency department and specialty care clinics, which includes Women’s Care and Surgical Care.

The hospital reports that the decision was made after extensive efforts to work with Amerigroup and fix problems.

“Patients continue to experience excessive delays in claim processing,” the hospital reported, “high rates or incorrect denials of coverage, and long waits for reimbursements.”

Dionisia Malecki, a spokesperson for Amerigroup, said the hospital’s announcement caught the Amerigroup Washington team by surprise.

“Amerigroup has been working collaboratively with Whidbey Health for many years, and we believe we have addressed concerns raised, so we remain committed to ongoing discussions in hopes that they will reconsider their primary care clinic decision,” a response from the team states.

About 1,000 people will be affected by the change. They have been contacted by the hospital and given instructions on switching to other Apple Health plans.

Likewise, Malecki said Amerigroup staff can help members transition from WhidbeyHealth primary care clinics to “other quality care providers and ensure their healthcare needs continue to be met.”

Amerigroup is the second Apple Health insurance company that WhidbeyHealth has limited in its acceptance.

Those with Molina health insurance require referral or authorization for services at the hospital and clinics.

Apple Health plans that are accepted at the hospital and clinics are Community Health Plan of Washington, United Healthcare Community Plan and Coordinated Care.

“Working with Apple Health to establish coverage is easy — patients sign up for Washington’s Medicaid or Affordable Care Act insurance coverage,” Conor O’Brien, WhidbeyHealth manager of marketing and community relations, said in an email.

“If the patient is at a certain income level, they are eligible for Medicaid or ACA without a premium, which places them on the Apple Health insurance plans,” he said.

O’Brien wrote that WhidbeyHealth generally contracts with managed care plans since they have the widest coverage for the community and have a network in place.

Hospital officials vet insurance companies based on reimbursement rates, the popularity of the insurance in the community and other considerations.

“Working with contracted insurance companies is a fluid and collaborative process that is ongoing,” O’Brien wrote.

The hospital Patient Financial Services department can answer questions and help people switch Medicare coverage. They can be reached at 360-682-2850.

State Medicaid can be reached at 1-800-562-3022.

Amerigroup members may call 1-800-600-4441 with any questions.

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