Care Oregon moving forward, United Audit
Dear Team,
I want to share both some encouraging news and some difficult news with you today.
The good news...
I heard from CareOregon this morning that they are indeed moving forward with contracting with MTPNW. I’ve been in ongoing conversations and negotiations for the past six weeks with them on behalf of you and our clients, and it’s clear that the persistence has paid off.
This is a huge win for us. CareOregon’s partnership helps us strengthen our mission: providing solid, high-quality mental health care to those who need it most, and making that care truly accessible. While we don’t yet have a signed agreement in hand, I just received an email from their contracting department confirming that we are exempt from the new policy being implemented on October 1st. We can continue to see our CareOregon clients without a disruption in their care. You may share this update with clients, please be mindful to manage expectations. Nothing is official until the contract is signed. We’re hopeful this will happen quickly now.
The harder news...
United has initiated a large-scale audit of our claims going all the way back to October 2024. It looks very likely that our clinic will be asked to repay a significant portion of those funds. Consequently, we are unable to submit claims to United/Optum after midnight on Wednesday, September 24.
I know this is not the news any of us wanted, and it will create stress for both clinicians and clients. Please begin reaching out to any United clients to help them transition to their “Plan B”, whether that’s self-pay with a superbill to submit for reimbursement to United, using another active insurance plan (if they have one), moving to sliding scale, or referring them out to clinicians who can accept United/Optum. Fortunately, this will not be a surprise to them as you’ve already started this conversation a couple of weeks ago.
How to hold this with clients
Here’s a gentle script you can adapt:
“I want to update you about your insurance coverage at the clinic. United has started a broad claims audit. Because of this, our clinic will need to stop billing to United starting September 24. I want to talk with you now so we can make a plan together. Options include temporary self-pay with a superbill that you can submit to United for possible reimbursement, sliding scale, another active insurance, or transferring care outside of our clinic.”
Next steps for all of us
Identify your United clients today and reach out to each of them individually over the next 2-3 days.
Hold the conversation with care, focusing on collaboration and options.
Make sure that your notes are completely up to date by next Wednesday.
Please know I recognize how much extra weight this places on you. The leadership team and I are here to support you in these conversations, and to help problem-solve if clients are in a particularly difficult spot.
Thank you for the incredible dedication you continue to bring to this work, to each other, and to your clients. Even when the systems around us feel unstable, our consistency and care is what makes the difference.
Please reach out to me if you have any questions or concerns.
With much gratitude,
Jenn