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Jacksonville mental health provider to deny Medicaid to patients

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  • Jacksonville mental health provider to deny Medicaid to patientsMore>>

  • Mental Health Meltdown

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JACKSONVILLE, N.C. -

For weeks 9 On Your Side has dug into North Carolina's mental health system.
     
Across the board, the major players all agree, it is a system in trouble.
     
Some providers are struggling for many reasons. One in particular is now having to turn patients away.

Doctor Ash Mikhail's practice, Coastal Carolina Neuropsychiatric Center in Jacksonville, will begin passing that problem on to its patients.
     
Specifically, those on Medicaid.

"The concept is unreal. Some of them are difficult and some of them are impossible. I think this is one of them that is impossible," said Dr. Mikhail.

Providers like Dr. Mikhail say the governing bodies over companies like theirs are tying their hands with red tape.
     
The managed care organization in charge of his company is Coastal Care in Wilmington. And its biggest issue at the moment involves patients paying with Medicaid.

"We decided not to work with them. And the reason for that is because we have experience working with the local mental health and it is a very negative experience," said Dr. Mikhail.

So as of April 22nd, this provider is pulling out, and all over the MCO not reimbursing for services provided to those patients.
     
Dr. Mikhail is blaming the paperwork.

"They started March 1st. We submitted about 400 claims. They were all denied," said Dr. Mikhail.

So 9 On Your Side dug deeper to find out why.
     
Dr. Mikhail says the mco Coastal Care entered incorrect dates into its billing system. He says it has nothing to do with his practice. He says these issues have been happening a while and that he's still waiting on payment for several back claims.

"It's not really about the money, because the money didn't change. The rates are the same. It's just the blocks to provide the service. It becomes too much administrative effort and almost harassment to get to the point that you are getting paid for the service you provide," said Dr. Mikhail.

9 On Your Side spoke to Coastal Care's area director Norman Foster. He disputes Dr. Mikhail by saying his company has no control over the paperwork.

"We adhere to a model that has been existing in this state for six or seven years. So therefore, the requirement for how a provider gets into our network and things that are required of them are really standardized across the state," said Foster.

Something Dr. Mikhail says hurts the patients the most.

The managed care organization says it is not asking Dr. Mikhail's practice for anything the current state system doesn't require.
     
Providers all over the state are experiencing similar issues.
     
9 On Your Side is at the forefront of the investigation and will continue to track and bring you the latest developments.

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