BEL AIR — A Bel Air mental health clinic that serves veterans says it was abruptly removed from the VA’s Community Care Network, leading to canceled appointments and uncertainty for veterans in the middle of treatment.
WATCH: Veterans’ mental health care disrupted after clinic removed from VA Network
Premier Wellness Healthcare owner Cindy says she first learned something was wrong on February 2, not through formal notice, but through a phone call from the VA asking whether her office had stopped accepting new patients.
Shortly after that call, a staff member received another call asking whether the practice had been removed from the network.
“That started the process of me looking to see what was going on,” Cindy said.
After contacting representatives, she says she received conflicting answers. Including being told the clinic had not revalidated its application and, separately, that it had never been in network with the VA at all.
She says neither explanation made sense.
“Even though we had been receiving referrals continuously and had been in network according to another representative from January of 202.”
Cindy says she was later told the termination date was January 23, but she never received written notice or warning. She also says Premier remains in good standing with every other Optum network plan.
The Department of Veterans Affairs (VA) oversees the Community Care Network (VACCN), which allows eligible veterans to receive care from private providers outside the VA system.
Optum, a subsidiary of UnitedHealth Group, serves as the third-party administrator for the VA’s Community Care Network in this region, managing provider participation and claims processing.
WMAR 2 News reached out to VA Maryland Healthcare System and they provided us with this statement:
“Optum manages provider networks, processes medical claims and connects Veterans with other providers if their existing community provider falls out of network. In its role as a TPA, Optum also ensures that private providers in the community network are vetted, credentialed, and meet VA standards. Optum may terminate a provider's participation if it finds that the providers are not in compliance with licensing or certification requirements, have unresolved audit discrepancies, for potential fraud, waste, and abuse, breach of contract, or any other failure to adhere to provisions outlined in the Provider Manual. Veterans, Care in the Community (CITC) staff, and VA providers can escalate perceived breaches in the standard of care to Optum for review and action if warranted. When a community provider falls out of the Optum network, the network ensures that Veterans using that provider are connected to others in the Optum network. VA CITC staff place care coordination notes into medical records of all Veterans participating in the CNN, and if on-going care is still needed, a new consultation is generated.”
“If we were removed from one Optum network forspecific reasons, we would be removed from all and all of our contracts would have been canceled,” said Cindy.
Because VA Community Care referrals are managed through Optum, the removal meant veterans using those referrals could no longer be seen at the clinic.
According to Cindy, about 10 to 15 veterans per week were impacted. Appointments were canceled for those receiving therapy or medication management through VA community care.
Licensed clinical social worker Lanika Wilson, who is also a U.S. Army veteran, says the disruption was alarming.
“There was a loss or a stop in continuation of care due to the network,” Wilson said. “It put a pause on all veterans abruptly where all of their care just abruptly stopped.”
Wilson says continuity of care is especially critical for veterans receiving mental health treatment. She warns interruptions can increase symptoms and, in some cases, raise suicide risk.
Veterans began contacting the clinic daily, asking for updates.
“They're they're devastated and it's, it's nothing right now that they can do,” said Wilson.
Cindy says she spent more than two weeks calling Optum and VA representatives, often sitting on hold, trying to get clarity.
“At least 10, 15 times to sit on hold,” she said, describing the effort to reach someone who could explain what happened.
She says she was told the reinstatement process could take four to six months.
Then, after WMAR-2 News reached out to both Optum and the VA for comment, Cindy says she received an email stating the clinic had been placed back into the network.
“It came after the Voice for Veterans came out to interview,” she said.
She says the reinstatement happened quickly and did not require new signed paperwork.
Now, veterans with valid referrals are being rescheduled and can continue receiving care.
But Cindy says she still does not know why the clinic was removed in the first place.
“Why? Why did this happen?” she said. “Why was I told this process could take 4 to 6 months when it was a click of a button?”
Optum provided the following statement:
“Due to a technical error, Premier Wellness was removed from our system. We apologize for any confusion and inconvenience this may have caused. We are working directly with Premier Wellness and the VA to ensure there is no interruption to Veteran care and all claims are paid appropriately.”
Cindy says Premier Wellness Healthcare will continue to serve veterans statewide through in-person and telehealth appointments, and affected patients are now being rescheduled.
She also tells WMAR 2 News that she hopes the situation highlights the importance of protecting continuity of care for veterans and ensuring communication breakdowns do not put patients at risk again.
