Some may lose UNMH providers

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@StephCHoover

Contract renegotiations between insurance provider Presbyterian Health Plan and UNM’s Health Sciences Center have left some patients looking for a new primary care provider.

PHP members who use UNMH as their primary care, which includes family medicine, internal medicine and pediatrics, can continue to see their UNMH providers until Dec. 31. But as soon as New Year’s Eve, some members will need to seek primary care services from Presbyterian Medical Group and other independent physicians contracted with PHP.

PHP President Lisa Farrell Lujan said they have already begun notifying members of these changes.

“Most of the 3,000 members assigned to a UNMH primary care provider have been notified by letter,” Lujan said. “We are also calling these members to assist them with choosing a new primary care provider and to schedule their first appointment.”

The changes would affect about 3 percent of PHP’s 420,000 members across New Mexico, Lujan said.

Billy Sparks, executive director of communications for the UNM Health Sciences Center, said UNMH will remain a Presbyterian network provider, although most services will require preauthorization. He said that UNM employees won’t be impacted by these changes.

“This decision will not impact LoboCare patients,” Sparks said. “We will continue to provide primary care for UNM employees under the UNM Medical Plan as administered by Presbyterian.”

Many of the providers in Presbyterian’s network have been in renegotiation contracts in order to provide affordable health care for their members, Lujan said.

Lujan said UNMH is still an important asset to PHP members and will continue to provide PHP members with behavioral health services and specialties, such as trauma, burn treatment and pediatric specialties.

“UNMH is a vital and important partner in health care for the people of New Mexico and for Presbyterian,” Lujan said. “In addition to being the state’s only level one trauma unit, they also provide many specialty services, particularly in pediatrics, that are not available anywhere else in New Mexico.”

The U.S. News & World Report ranked UNM School of Medicine’s primary care program 19th in the nation for 2014. Sparks said this makes the school among the highest quality primary care programs in the country.

“UNM hopes that Presbyterian will include our primary care services in their future offerings,” he said.