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Lakeland Care Terms McLaren Contract

December 14, 2017

Lakeland Care announced at the Annual Payor Conference on 10/18/17 that the Lakeland Care Network had issued a termination notice to McLaren Health Plan on 9/11/17 indicating de-participation from their Medicaid Health Plan effective 12/31/17.

 

Following the termination notice, Jim Nason met with the State of Michigan, Department of Health and Human Services, Managed Care Plan Division and outlined the unresolved issues with McLaren Health Plan.  He also spoke with representatives from McLaren Health Plan with the desire to resolve the operational issues that were affecting our ability to provide the highest quality and timely patient care.  Unfortunately, Lakeland Care was unsuccessful in resolving these issues, and as such, the termination of this plan will be 12/31/17.

 

What does this mean for your practice if you have any current McLaren Medicaid members?

  • As a primary care physician, you are unable to see any McLaren members as of 1/1/18.  You can direct your McLaren patients to call the McLaren Customer Service Line at (888) 327-0671. They will assist the member in finding a new PCP. 
  • If you are a specialist practice, you can continue to see McLaren patients, but all services must be pre-certified prior to any services being performed, up to and including office visits, lab workups, imaging, consults, or any procedure.  You may also indicate that you do not participate with this health plan, and the patient then would need to call the above listed customer service line, and they will be redirected to an in-network specialist and hospital facility.

The patient does have the right to choose a different Medicaid Health Plan in the month that their open enrollment occurs. That month varies based on the last 2 digits (01=Jan., 02 =Feb., 03=Mar. etc.) of their Medicaid Case Number.   In order to determine that month, the patient would need to call Michigan Enrolls at (888) 263-5897 and request to be moved to a different health plan.  McLaren has approximately 3,700 covered lives in our tri-county market.  Lakeland Care Network currently has Medicaid contracts with Meridian Health Plan, Priority Health Choice, and United Healthcare Community Plan. 

 

As always, we appreciate the exemplary service our Lakeland Care physicians and staff provides to the residents of Michigan’s Great Southwest.  If you have any questions on the details of this termination, please feel free to call Jim Nason at (269) 927-5398.