PrairieCare, Medica Dispute May Cost Patients

The battle between the mental health provider and insurer reached all the way up to Gov. Dayton after PrairieCare sent him a letter alleging Medica was breaking contract lines.

PrairieCare has been a big player in mental health treatment among children and teenagers since its first 25-bed hospital opened in Maple Grove in 2011. But a heated dispute over proper patient care between the mental health provider and its insurer Medica could pose a threat to hundreds of at-risk patients.
 
Minnetonka-based Medica is claiming PrairieCare’s costs to operate are far beyond other hospitals and that its patients are being held an average of three days longer than other health care facilities.
 
Larry Bussey, the communications director for Medica told the Pioneer Press that PrairieCare is asking for “increases in services in the range of 200 to 300 percent,” which is breaking the realm of affordability for the insurer.
 
PrairieCare is insisting that money isn’t the issue and that it’s only trying to keep up with patient demand. In the Pioneer Press story, PrairieCare consultant Tom Lehman added, “patients that have attempted suicide or have suffered a severe psychotic breakdown cannot be made ‘well’ in seven days.”
 
The dispute could reach a boiling point where, if unresolved, PrairieCare would no longer be a provider of inpatient and partial-inpatient services for Medica’s patients starting October 20.
 
PrairieCare has sent a letter to Gov. Dayton with an assertion that Medica is violating its state licenses and contracts. Specifically, the mental health provider is accusing Medica of creating unreasonable care timelines, pushing patients out the door before it is medically appropriate.
 
The potential outcome to this debacle is a sizeable upcharge to PrairieCare’s services for Medica’s patients, which altogether amount to 1.5 million people.
 
In August 2014, TCB ran a feature on PrairieCare: how it was founded and found success through adding facilities in Brooklyn Park, Edina, Woodbury, Rochester and Chaska.