Mental health provider contacts ABC11 Troubleshooter, gets close to $200,000 in claims paid
CUMBERLAND COUNTY, N.C. (WTVD) -- A Cumberland County mental health provider is frustrated after she says her practice is owed close to $200,000 for claims. "I mean it's hard, right? I mean I think I spent the past couple of weeks in tears and just trying to figure out a solution," says Amber Kennedy of Spring Lake Counseling, Inc.
When she reached out to ABC11 Troubleshooter Diane Wilson in February, she said she's desperately trying to continue to see patients. "There's an ethical responsibility to be able to provide, but we can't provide if we don't have a roof over our heads and we don't have a roof over our heads unless our bills get paid," Kennedy said to Wilson.
Kennedy says her bills from one of the insurance companies, Humana Military PBGA, are not getting paid. She says the problem started when Humana Military transitioned their claim processor. Kennedy claims she did all the necessary paperwork needed for her practice, which includes 30 providers.
"We submitted our claims, as we typically would every day after seeing a client and 30 days went by and our clients are just kind of sitting in the queue for Humana Military."
After 30 days without payment on claims, Kennedy says her practice continued to contact Humana Military. Kennedy told Wilson, "Then the most recent response is there's no eta on payment of claims when we have almost 800 claims sitting there."
With that many unpaid claims, Kennedy says it totaled close to $200,000, which took a huge financial toll on keeping the counseling center open. "If we have 800 claims sitting there now and we continue to see folks that are Humana Military and we don't know if we'll ever get payment, there is no way that our doors can stay open," said Kennedy.
Humana Military does have this posted on their website acknowledging that their usual processing times have been delayed due to a major system transition and that they are actively working to expedite resolutions and anticipate returning to our standard turnaround times within the next several weeks.
When it comes to Kennedy's unpaid claims, a Humana Military representative tells ABC11 Troubleshooter they're working with Kennedy to ensure they resolve her concern promptly. They added in part, "We take our commitment to TRICARE East Region beneficiaries and providers very seriously, and apologize for the inconvenience and frustration this problem has caused. Our priority is always TRICARE East Region beneficiaries and their ability to get access to care. We are working closely with impacted providers to ensure they continue to care for TRICARE East Region beneficiaries." The representative with Humana Military also added, "We have made the business decision to send advance payment to the most vulnerable providers who have submitted claims. This is a payment to assist with cash flow for providers while we resolve the remaining systems challenges. Specifically, we are issuing an advance payment to many Applied Behavioral Analysis (ABA) providers and non-facility behavioral health providers. We are also actively addressing escalated complaints with urgency."
The good news for Kennedy is that after Troubleshooter got involved, she felt a big relief. She says Humana Military sent her checks to cover the 800 pending claims, which totaled $200,000.
Kennedy says it helped her practice continue providing care to its patients. Kennedy does add, however, that since getting the payment on those claims, all claims she has filed since, she says she is still waiting for payment on those claims.
In response to those claims, a representative says, "Humana Military continues to work with Ms. Kennedy to ensure we resolve her concerns promptly. Claims are flowing through our system and our team is working diligently with our claims processing vendor to process the backlog of impacted providers' claims, including the remaining claims from Ms. Kennedy."
