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GMH terminating agreement with TakeCare

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by Mindy Aguon

Guam - The Guam Memorial Hospital issued a notice to terminate its direct payer agreement with TakeCare Insurance because of a "pattern of coverage denial that the hospital is uncomfortable with", according to hospital legal counsel Tom Fisher. He says TakeCare has a pattern of denying coverage for many of their customer's hospital bills. 

For example, an individual who had a broken limb had to spend the night in the hospital before he could be seen by an orthopedic surgeon.  Fisher claims TakeCare refused to cover the overnight stay.

Hospital management also found that the insurance carrier often won't pay hospital bills for those with dual insurance such as Medicare, which forces GMH to absorb the costs.  TakeCare has also been paying "well below" what is billed on a monthly basis.

The insurance carrier is making every effort to avoid termination of the agreement, which is set to begin on March 20.

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