GMA hosts health insurance forum - KUAM.com-KUAM News: On Air. Online. On Demand.

GMA hosts health insurance forum

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GUAM -
 
"We have a 160,000 population we're short 30 fulltime primary care docs"
 It's a reality that Seventh Day Adventist Guam Clinic CEO Ted Lewis says is unfortunate residents have come to accept.

Having only lived on island for a year, he's beginning to understand why this is so.
Just last month, the clinic announced plans to terminate their contract with TakeCare insurance because the company had refused to reimburse the clinic for services of certain physicians.
 
"As I broke down to look at it its primarily a situation where someone comes in that we're bringing in that's in a specialty area where FHP has a physician or what they feel is an adequate number. We're going to be denied because they offer that service" Lewis explained.
 
Lewis' sentiments were echoed by internal medicine practitioner, Dr. Felix Cabrera.

"I was not credentialed with TakeCare I didn't' think anything was wrong with me. I thought I had good training. I'd didn't think that was an issue I knew it was a business model they were following and I understood that --  even as unhappy as I was about that" Cabrera mused.
 
More and more, Cabrera found himself losing his patients.
 
"One of them in tears saying her employers are now moving to TakeCare and that she can no longer see me and when you break something as sacred as a doctor patient relationship that you worked so hard to build, there's something fundamentally wrong with that" Cabrera added.
 
While some doctors can't get credentialed, others are left waiting for payments.
Committee chair on healthcare Senator Dennis Rodriguez Jr. says the Legislature's doing their part - introducing and amending the Prompt Payer Act to increase efficiency, but it's going to take more from GMH and private clinics.
 
"As we move forward to address this it's important to keep in mind that what is currently lacking is universally practiced electronic medical records and billing system within all clinics. Which would thereby promote timely collection by the service provider. In order for the hospital to avail of this aggressive 14 day collection of claims either by our hospital to our insurance providers they must first go out and outsource and privatize their billing and collections because we know that's where the problem is" the Senator reasoned.
 
Meanwhile, with open enrollment underway, Calvo's Selectcare's Frank Campillo says GovGuam agencies will be briefed on the different plans. We should note only Calvo's SelectCare, Staywell, and Netcare were present at last night's forum with a no-show from TakeCare.

 

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