TULSA, Okla. — Billing issues are causing major concerns for some Green Country healthcare providers.
It comes after the state switched to SoonerSelect earlier this year.
“Our providers are stressed,” said Therapeutic Life Choices Clinical Director Tiara Delonia.
Inside a little house on the corner of 17th and Carson in Tulsa, more than 130 providers work with some of Tulsa’s most vulnerable people.
“We work a lot with clients that are homeless,” said Delonia. “We work with, on that spectrum, some of your more severe mental health concerns.”
For the 2,500 clients who step through Therapeutic Life Choices' doors, the therapists are doing everything they can to help.
At the same time, the providers said they aren’t getting paid the same way anymore.
“It’s just very disheartening to put all this energy into providing these services and trying to support the needs of the community, but then on the back end I’m having to worry about my paycheck,” said Delonia.
Delonia said since the state switched to SoonerSelect in April, contracting with 3 insurance agencies, Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma, and Oklahoma Complete Health, they’ve seen multiple issues.
“We still have a lot of money that we haven’t received for our providers just for the services they’ve been providing,” said Delonia.
Delonia said they aren’t being reimbursed at the same rate, only getting about 75% of their previous rate.
She also said some claims are being outright denied. Some of those denials are due to errors, like a letter a client received saying they were required to get a primary care physician’s referral, she said.
The agency said that’s not the case.
“I know it’s not just exclusive to our agency,” said Delonia. “It’s been going on for months and we’re just worn out.”
The Oklahoma Health Care Authority oversees the SoonerSelect program.
In a statement, the agency said:
“Providers across the state have been paid over $400 million in claims in addition to enhanced directed payments of $252 million. If a provider is experiencing a delay in payment or challenges during this transition, reach out to SoonerSelect@okhca.org or attend one of the numerous office hours opportunities available on our website. OHCA has held numerous in-person office hours in addition to regular virtual office hours so that every provider is equipped to be successful with SoonerSelect.”
In response to the specific issues Therapeutic Life Choices is facing, OHCA said,
“Our records show that this provider contacted one of the plans recently and a coding error was identified and corrected, with claims reprocessed promptly. Prior to this outreach, the provider reached out in early June claiming they weren’t receiving payments from one of the contracted entities. After investigating the issue, it was discovered that the provider’s billing agent had not submitted any of their claims for processing. The CE notified the provider of the issue with the provider’s biller. If any issues remain, providers should contact OHCA at SoonerSelect@okhca.org.
OHCA was notified that one of the SoonerSelect contracted entities experienced a system glitch in July, which caused some claims to be incorrectly denied due to a lack of PCP referral. However, SoonerSelect plans do not require PCP referrals for members to see in-network providers. Once identified, the system glitch was promptly corrected and any claims that were incorrectly denied for lack of a PCP referral are being automatically reprocessed.”
For Delonia, she said she wants the entire infrastructure of the program to be fixed, so they can focus on what really matters.
“We just really want this resolved so our clients can focus on their services, and our providers can focus on providing the services, and that’s it,” said Delonia.
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