by Mindy Aguon
Guam - The Guam Memorial Hospital wants to set the record straight on the real reason it decided to terminate the direct payer agreement with Takecare Insurance. The following is a press release issued by the hospital on Wednesday night in light of a heavy marketing campaign by Takecare:
The Guam Memorial Hospital is becoming concerned about a marketing campaign TakeCare is pushing on the people. The marketing campaign is flush with very misleading statements. The hospital has no choice, at this point, but to reveal the truth about what has happened over the past few years that led to a decision to cancel TakeCare from its rolls.
To set the record straight:
A few weeks ago, the hospital's Board of Trustees notified TakeCare that their company will not be recognized after March 20, 2012. They did this because of TakeCare's practice of denying coverage to members.
Denying Coverage to Their Own Members Who Use GMH
Now, all insurance companies look at the claims of their members who use the hospital; and by some degree, all insurance companies deny coverage based on their standards. The difference is that TakeCare denies coverage at a much higher rate than any other insurance company. Unlike other insurance companies, they do not inform their members in a timely manner while in the hospital that they will not be covered for one reason or another. When those denials of coverage are not appealed, normally their accounts will be transferred to self-pay. And TakeCare members will be left behind.
"When you shop for an insurance company, you're looking for the one that's going to cover you when you absolutely need them," hospital administrator Rey Vega said.
Hospital Negotiated on Behalf of TakeCare's Members & GMH Finances
The hospital, even after the controversy broke in the news, decided to speak with TakeCare in good faith and in hopes that TakeCare would change its practices. This is why the hospital has been silent on this issue. As late as last week, hospital management sat down with TakeCare officials to iron out agreements that WOULD HAVE been presented to the Board of Trustees tomorrow. These verbal agreements included the necessary changes to TakeCare's unfair practices against their members who use the hospital.
"We have been the ones advocating for TakeCare's members, when it should be TakeCare looking out for the best interests of their members," Vega said. "So when they put out ads suggesting that they pay the hospital very well, we wonder what in the world they are talking about. Not only are those numbers skewed, they're ignoring the fact that they refuse to pay for what matters the most – the hospital care of their own members!"
Wrong Information in Marketing Campaign
TakeCare has presented financial information to the public challenging the board's reasons for the notice of termination. They've cited a CalvoTenorio Transition Team report by the subcommittee on health. They've asserted from these reports that TakeCare owes less money to the hospital for billed claims than other insurance companies. This was the basis for their argument that TakeCare should not have been given that notice.
There are two things very wrong with saying that TakeCare is a better hospital client because it owes less money to the hospital for billed claims than other insurance companies.
1. TakeCare should owe a lot less to the hospital than what it has owed because it has far fewer members than the insurance carrier for the government of Guam and its retirees. If you rate out the number of members using the hospital from each insurance carrier and the amount owed to the hospital, TakeCare pays at a rate much much lower than other carriers.
2. The information in that report was only for billed claims. The entire reason for removing TakeCare is that they are denying claims at a very high rate. Those claims that are denied don't show up in the chart of ‘billed claims.' Those denied claims become ‘self-pay' claims and, thus, part of the reason for the very high rate of self-pay receivables at GMH.
GMH Left to Defend the People
Put simply, TakeCare is leaving many of its members out to dry and causing the hospital to incur the charges of TakeCare members who were left without insurance coverage.
"That is not right, and it's high time I let the people know just how wrong TakeCare is," Vega said.