ALBUQUERQUE, N.M. — Lovelace Medical Group/Southwest Medical Associates said it will terminate its contract with Presbyterian Health Plan on Jan. 1, which could limit health care choices for about 7,400 customers.
A letter dated Sept. 5 said Lovelace Medical Group/Southwest Medical Associates providers will no longer accept Presbyterian insurance, but it did not spell out a reason. The change does not affect any appointments that are scheduled before Jan. 1.
In its letter, Lovelace suggested patients choose a health insurance plan that Lovelace does accept, including Blue Cross and Blue Shield of New Mexico, New Mexico Health Connections, Molina Healthcare New Mexico, Retiree Health Care Authority, TriCare or United HealthCare Community Plan.
Lovelace refused comment Wednesday on the reasons for its decision.
A Presbyterian spokeswoman said Presbyterian Health Plan never had a contract with Lovelace Medical Group, but rather an “evergreen contract” with Southwest Medical Associates, a multi-specialty medical practice that the Lovelace parent company, the for-profit Ardent Health Services, acquired in 2012.
“We were recently notified by Southwest Medical Associates, an organization affiliated with Lovelace Medical Group, on their decision to no longer participate as a provider in our network, effective Dec. 31, 2017,” said Brandon Fryar, Presbyterian Health Plan president in a statement. “We are working collaboratively with community (medical) providers as well as Presbyterian Medical Group to ensure the 7,400 members impacted by Lovelace’s decision continue to have access to quality care.”
Those with questions can contact Presbyterian at 505-923-8100.
Presbyterian is the state’s largest locally owned health plan, providing coverage to 466,000 members in New Mexico. The for-profit subsidiary of Presbyterian Healthcare Services has members in commercial, Medicare and managed Medicaid plans.
Back-and-forth between hospitals and insurance companies over reimbursement rates is fairly routine. They periodically re-up their contracts with each other, spelling out what the insurance companies will pay for literally thousands of procedures, from clipping in-grown toenails to brain surgery.
Hospitals typically ask for adjustments to their payment rates from affiliated insurers to pay for rising medical supply, pharmaceutical and other operating costs.