Guam News - Guam News

Guam - In its latest letter to subscribers, TakeCare management says it has been meeting with Guam Memorial Hospital Administrators in an effort to convince the Hospital to resume acceptance of  the company's health insurance. But no agreement has been reached.

"Although, we have yet to reach an agreement," states the letter, "TakeCare has actively and will continue to work with GMHA Administrators until a resolution is found."

The subscriber letter, released Friday, also states that TakeCare has spoken with Health Committee Chair Senator Dennis Rodriguez about the stalemate. The letter does not say what, if any action, the Health Committee Chair will take.

The GMH Board's January 19th decision to terminate TakeCare's Direct Payer Agreement means that GMH will no longer agree to bill TakeCare for hospital charges incurred by the insurer's subscribers. If you are a TakeCare subscriber, GMH will hold you responsible for paying your bill and your TakeCare card will no longer be accepted, as of March 20th, when the termination becomes effective.

However, if TakeCare can not convince GMH to change its mind before the termination deadline, the company has advised their subscribers to bring their hospital bills to TakeCare for payment.

The exact number of TakeCare subscribers effected by the Hospital Board's January 19th decision has not been disclosed, but it is believed to be in the thousands. Among TakeCare's subscribers, are the civilian employees [and their families] at the island's military bases. [The employees of PNC News and the Sorensen Media Group are also subscribers].

"We continue to keep our customer’s best interest in mind. TakeCare Management has been diligently working on solutions to enhance our member’s experience," states Friday's subscriber letter.

TakeCare management has declined to answer questions from PNC News.

However the Subscriber letter from TakCare does contain a link to a recording made by TakeCare COO Jeff Larson which answers some frequently asked questions about the impact of  GMH's decision to terminate TakeCare's Direct Payer Agreement.

Click HERE to HEAR TakeCare COO Larson's presentation

GMH Attorney Tom Fisher explained to PNC News that the Board terminated TakeCare's Direct Payer Agreement because TakeCare has a pattern of  denying coverage which he called "unreasonable." 

The Attorney provided PNC News with a chart showing that in October, November and December of  2011, GMH was only able to collect $1.06 million of  the $2.12 million GMH billed TakeCare.  Fisher said  "too frequently we have have had TakeCare customers presenting themselves at the hospital for treatment and they are treated and TakeCare refuses to pay for that treatment. As a result, the hospital and ultimately the Guam taxpayer end up paying for the treatment."

However,  Senator Ben Pangelinan questioned that explanation pointing to a December 2010 report from the Calvo Administration's transition team showing  that TakeCare was one of the Hospital's best payers.

Moreover, even if TakeCare's payment record has suddenly become worse since December 2010, Pangelinan asks why would the Hospital chose to make its collection job even more difficult. By cutting off  TakeCare, he points out, the Hospital has chosen to collect from individual self-payers, the worst category of payers.

In addition, COO Larsen, in the above recording, explains that during 2011, [after the December 2010 transition report] TakeCare continued to be be one of the Hospital's best payers. Again raising the question of  why TakeCare was terminated when other insurers, like Calvo's SelectCare and Staywell, had payments records far worse that TakeCare.

Pangelinan has called on Health Committee Chair Senator Rodriguez to convene an Oversight Hearing to get answers from both GMH and TakeCare.

Rodriguez, who called the Hospital's decision "extreme" has so far declined to say whether he will, or won't.

READ TakeCare's February 10 letter to subscribers:

February 10, 2012
Hafa Adai TakeCare Employer Group:
In the last few weeks, TakeCare Management has met with GMHA Administrators to discuss the Direct Payer Agreement. As we continue to negotiate with GMHA, TakeCare Management has also met among others, with Sen. Dennis Rodriguez, Chairman of Health and Human Services.

TakeCare and GMHA are both integral parts of the Guam community and have for decades worked together to provide health care to the People of Guam. It is in the interest of GMHA, the People of Guam and TakeCare that the contractual relationship between GMHA and TakeCare as a third-
party payer be continued. Although, we have yet to reach an agreement, TakeCare has actively and will continue to work with GMHA Administrators until a resolution is found.

We continue to keep our customer’s best interest in mind. TakeCare Management has been diligently working on solutions to enhance our member’s experience. Although we are confident we will come to a resolution with GMHA, we have identified opportunities that will increase our member’s options and help mitigate the issues we are experiencing with GMHA. We are currently working on the following initiatives that will add value to our plans and services:

Expansion of FHP Urgent Care Hours of Operation – FHP Urgent Care will be expanding the hours of operation to 7am – 11pm, 7 days a week. This change will take effect 2nd Quarter of 2012.

Expansion of our Airfare Benefit Program – The expansion our airfare benefit program will give our members the option to obtain both outpatient and inpatient services in the Philippines at our participating providers (conditions and limitations may apply). The airfare benefit will include airfare, lodging and transportation to and from the airport. The new airfare benefit program will be available to TakeCare members within the next 30 days.

Consult a Doctor Program – We will launch the Consult a Doctor Program within the 1st Quarter of 2012. More details regarding the program will be forthcoming within the next couple weeks.

We thank you for your patience and understanding while we continue to work with GMHA towards resolution.

Sincerely,
Jeff Larsen
Chief Operations Officer

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