Local providers raise concerns over CareSource payments

DAYTON, Ohio (WDTN) -  Some local CareSource providers claim they're not getting paid in a timely manner and they say that is impacting the patients who need them the most.

Inside the doors of Dr. Gordon Harris and Associates, treating mental health is what it's all about.  The practice takes pride in helping those in the Dayton community, including people who have limited options for health insurance.

"It's the people who really need it the most. A lot of them are low-income people or disabled people," said Psychologist, Dr. Gordon Harris.

Many of these clients use the managed health care plan, CareSource to get the health care they need, but lately this practice has had to turn those clients away because they say they're not getting paid by CareSource.

"They are frustrated," said CareSource Provider, Georgeanna Jane Shirley

"In this business you are basically an hourly worker and you can't afford to work for nothing," said Dr. Harris.

Jane Shirley is the CareSource provider of the practice. She reached out to 2 NEWS Investigates saying she is owed money for seeing 8 different patients since 2015.

Those claims exceed four thousand dollars. She says the practice has tried everything to get her paid.

"She has submitted and re-submitted and re-submitted the statement for billing and sometimes they say it didn't come through or we haven't received it or one time I was told I was not on the provider list," said Shirley.

"We probably submitted the same claim 6 or 8 times and every time they disappear, they were not right, some number was missing. There was nothing we could do to satisfy them," said Dr. Harris.

2 NEWS Investigates heard from at least three other providers who didn't want to be named but who are all listed on CareSource's provider website.

They describe the same type of delays and confusion with getting their claims paid. The providers we spoke with say the inconsistencies have them thinking twice about accepting CareSource, which could limit the amount of providers who are available to see patients.

"When a lot of providers are no longer accepting a certain insurance and that's the only insurance they qualify for -how are they going to be taken care of? And that is what is so frustrating," said Shirley.

CareSource
CareSource

2 NEWS Investigates took these concerns to CareSource. They refused to answer our questions on-camera.

Instead they released a statement that says, "we value the 65,000 health providers who make up our network of providers. Providers are an integral part of the team that helps members live better lives."

The statement says they follow all state regulatory requirements for processing claims and payments and out of the millions of claims they process every year, occasional issues do arise.

They didn't go into any further detail about those issues or how they're fixed but after we told them about the delay in payment owed to Jane, she has since gotten a check for the total amount owed to her.

And while Jane is happy to be paid, she believes there is an underlying issue that she hopes is addressed.

"If service providers can count on being reimbursed in a timely fashion they are going to be much more willing to see people who have this insurance so that would automatically improve services to the public," said Shirley.

If a provider has questions or would like to speak with someone at CareSource, they can call:

800-488-0134 8 a.m. – 6 p.m.

 

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