TakeCare management speaks about agreement

by Mindy Aguon

Guam - While the hospital board canceled its meeting for this week, TakeCare Insurance is still optimistic that a direct payer agreement that was terminated last month will be rescinded. Now TakeCare's management speaks out hoping to clear the record as the provider believes it's been singled out and termination of the agreement would be a disadvantage to all the parties.

"It really makes no sense that we would try to hurt the quality of care at GMH or put them at a financial disadvantage," said TakeCare Health Plan Administrator Jeff Larsen. He doesn't understand why the hospital board chose to terminate the direct payer agreement with the insurance provider after concerns were raised about TakeCare's pattern of coverage denial. TakeCare members will be considered self-pay patients at GMH beginning March 20, but the company has been in active discussion with hospital management to have the agreement restored.

Larsen says GMH's records even show that TakeCare has been a consistent payer and in fact the provider has been one of the top three payers between 2007 and 2010. "We are a consistent and stable revenue stream for the hospital to the point of why would they make this decision? You know, I don't know. TakeCare owes substantially less to GMH than the other major carriers for invoices over 180 days old," he said.

Larsen adding TakeCare was the only insurer in 2011 to actually reduce their receivables significantly. "We're not refusing payment on clean claims and I think the misperception that's out there is that in someway TakeCare is excessively denying claims and our analysis shows a much different scenario," he said.

The hospital provided 44 examples of TakeCare's alleged excessive denials, but Larsen says more than half of those claims had issues with eligibility while others were inappropriately billed to TakeCare as the primary provider when Medicare should have been billed. TakeCare has been trying to work with the hospital to resolve issues with the hospital's eligibility verification process.

"I think part of the challenge isn't so much the billing but the backup and the detail that's required to adjudicate a claim is typically missing or non existent," he said. "That's been our biggest challenge in working with the hospital to clear that up."

GMH has consistently had challenges collecting from self-pay patients and Larsen says terminating the agreement would only increase the number of patients they need to collect from which he contends makes no financial sense. And if the board chooses not to rescind the termination, come March 20, Larsen says TakeCare has operational processes in place to keep its members from feeling the impact in their pocketbooks.

The health plan administrator meanwhile said it would be inappropriate to comment on Guam Radiology Consultants' recent decision to terminate its contract with TakeCare effective March 10.

"There are services that are available on Guam that GRC offers but other providers offer. Our perspective is this TakeCare and FHP has always tried to expand the service offerings that we provide to our members," he said.