UNM will remain a provider of specialty services to Presbyterian Health Plan members, but a UNM statement said Presbyterian “will require preauthorization for most services” under terms of a new provider agreement that takes effect Nov. 1. Members will have until Jan. 1 to change providers for primary care.
Lisa Lujan, the health plan’s president, told the Journal that UNM is “a high quality provider, but we couldn’t reach agreement on reimbursement levels.”
By providing primary care through Presbyterian’s own medical group and other providers with whom the plan contracts, she said, the service should be 10 percent to 15 percent less expensive than when provided by UNM.
Lujan said Presbyterian is contacting affected plan members to help them find a new primary care provider. She said the change probably will mean primary care physicians in the network will handle from five to 10 more patient visits per month.
UNM Hospital CEO Steve McKernan said patients who use UNM for other services should see no change. He said patients will set up appointments as they always have, and UNM will obtain health plan authorization for the care.
“UNM and Presbyterian have agreed that use of preauthorization is a good mechanism to reduce overutilization (of care) and improve the system,” McKernan said. “UNM will still be fully on the Presbyterian network.”
McKernan said most Presbyterian members receive services like stroke, trauma and specialty pediatrics care at UNM, not primary care. He said between 7,000 and 8,000 Presbyterian plan members use UNM for a variety of services.
The change will not affect patients who use UNM’s behavioral health services, Presbyterian’s patients in the Intel Connected Care program, or UNM’s employees, including those using the LoboCare Network.