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12 23Sat11012014

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Back Local News ‘Hospital billing issues led to TakeCare contract termination’

‘Hospital billing issues led to TakeCare contract termination’

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AFTER allegations about TakeCare Insurance’s financial negligence with the Guam Memorial Hospital stunned the healthcare community, the insurance agency now wants to clear the record and tell its side of the story based on factual evidence.

“Our perspective is that we partner with the hospital,” said Jeff Larsen, TakeCare chief operating officer. “The facts are that we’ve actually paid the hospital in a timely manner; we’ve been one of their best payers historically; we’re one of the largest single sources of revenue that they’ve counted on.”

Larsen explained that some of the concerns dealt with the hospital’s internal billing issues, which he says is nothing new.
“Their billing processes are a challenge and we’ve experienced some of that. Some of their challenges have created challenges on our side, and their accounts receivables have been known to be historically inaccurate,” Larsen said.

“I think once the facts were actually vetted through ... I believe that’s why the administrators are now actually taking another look and saying, ‘Yeah, we really didn’t do the right thing,’” he added.

TakeCare’s comments stem from the hospital administration’s action in January notifying TakeCare that it would terminate its direct payer agreement. The notice was given following a GMH Board of Trustees decision to terminate the contract.

The notice, Larsen said, seemed to have been made in haste and as a result of a recommendation to the hospital board and administration without first consulting the insurance agency.

GMH legal counsel Atty. Tom Fisher earlier explained to Variety that the hospital’s decision was based on TakeCare’s pattern of denying coverage that is routinely covered by other insurance agencies doing business with GMH.

Denials

“When you look at the patterns of excessive denials, I think that by any reasonable standard they’re not excessive,” Larsen said.

For example, in a handout provided to Variety, Larsen said 44 claims were sent to TakeCare that were part of the “excessive” denials. But over half those claims, Larsen said, were erroneously billed as they were neither TakeCare members nor did they have benefits with the insurance agency.

Another 22.7 percent, or about 8 of the claims, were mistakenly billed to TakeCare when it should have been billed to Medicare, Larsen said.

Sen. Dennis Rodriguez Jr. last week sent out a press release stating a “compromise” had been reached between TakeCare and GMH. Rodriguez said he was confident that GMH would recommend that its board reinstate the TakeCare contract.

A board meeting was scheduled for today but has been postponed to March 1. If the Board of Trustees does not reinstate the contract, effective March 20, TakeCare insurance members who receive services at GMH will be treated as self-pay patients.

“Self-payer is one of the worst possible scenarios for the hospital, and self-payer doesn’t benefit the hospital and the island – and certainly not our 30,000 members or our employees,” Larsen said.

Larsen concluded: “[GMH] is the island’s only hospital. The way we do business is not intended to hurt the quality of care at GMH or their financial standing. Our employees, myself and our members rely on GMH. We go there for emergent care; we go there if there’s a condition that exists that can’t be handled at a clinic or an outpatient setting, so GMH is an integral part of the framework here in terms of health care.”

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