Of the 312 complaints received in May, 111 involved Sunshine Health Plan, Florida’s largest managed care provider, according to the report.
Those figures come from a report given to the Medicaid Managed Medical Care Long Term Care Advisory Subcommittee by the Florida Agency for Health Care Administration, which oversees the state’s Medicaid program.
Paula James, the agency’s bureau of plan management operations administrator, said the complaints regarding Sunshine were related to its acquisition of Staywell and subsequent merger. The plan was fined $9 million in March for not making payments or delaying payment on more than 121,000 claims.
The Florida Agency for Health Care Administration receives complaints from providers and from Medicaid beneficiaries, according to the report. In May, 72 percent of providers’ complaints involved claims. Claims processing accounted for most of those calls. Fifteen percent of the complaints involved a dispute with a plan over the accuracy of the information given from the payer to the provider.
Half of beneficiary complaints in May stemmed from an inability to access medical or dental benefits, according to the report. Ms. James said that in many instances it’s a case of the beneficiary not knowing how to access the information or not requesting assistance from the plan. In other instances, it’s a situation where beneficiaries asked for a particular provider, and that provider is not in network, she said.
