Aetna: $2M in GovGuam employee claims paid; 508 requests for off-island care approved

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Aetna started processing medical claims from government of Guam employees on November 4 when eligibility had been finalized following the completion of open enrollment on October 12.

Aetna’s medical coverage for GovGuam employees became effective on October 1.

Since then, according to a report Aetna provided to the Department of Administration, nearly $2M in claims have been paid out and over 500 requests for off island medical care have been approved.

The Department of Administration released the following numbers provided by Aetna on the initial claims filed by GovGuam employees who have enrolled in the company’s health insurance programs.

* 17,597 claims filed. 15,672 or 89% have been paid to date totaling $1,982,607.

* 13,153 were medical claims and 2,519 were dental claims.

* Total paid 12,211 or 78% were auto-adjudicated which means they process automatically.

* Average aging of claims – 10 days.

Aetna is encouraging providers to submit their billings electronically because that will allow faster processing of those claims.

Off-Island care

Aetna also reports that 508 applications for off island medical care have been approved. The applicants were approved for treatment at medical facilities in the mainland U.S., South Korea, Taiwan, Thailand, and the Philippines.

Aetna touts that it has medical professionals situated in at least five different time zones ready to respond to providers who need to discuss next level care for their patients.

Protests

The GovGuam enrollment period was scheduled to begin in August, but it was delayed by a protest filed by both TakeCare Insurance. That protest was denied by the Public Auditor on July 30.

The Governor approved the bid submitted by Aetna on September 9.

Open enrollment began on September 23.