VIDEO: Pangelinan to GMHA – Explain Termination of One of Your Best Payers

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Guam – A chart attached to Senator Ben Pangeleinan’s letter calling for an oversight hearing on the TakeCare contract termination shows that TakeCare was among the better payers to GMH in Fiscal Years 2007 thru 2010.

 

The chart is titled “GMH Collections over Billings Analysis 2007 to 2010”.

According to Senator Pangelinan’s letter, it was compiled by GMH for the Calvo transition team in December of 2010.

SEE the chart showing the percentage of what health insurers paid compared to what GMH billed [scroll down past Pangelinan’s letter]

The chart compares the 4 principal health insurers on island, and self pay clients, showing what GMH billed, and what the health insurer, or individual, paid.

According to the chart, over the course of the 4 years covered, TakeCare was the best payer in 2007, second ranked in 2008 and 2010, and third ranked in 2009. TakeCare paid a low of  70% of what GMH billed in FY 2009 and a high of 78%  of GMH’s billings in 2008.

The GMH Board voted last Thursday night to terminate its contract with TakeCare, without explination. On Tuesday, GMH Attorney Tom Fisher explained the decision saying the reason why the TakeCare contract was cancelled was because of the insurers “unreasonable denial of coverage.”

“We present the bills to TakeCare,” said Fisher, “and TakeCare denies coverage. And we think their pattern of doing so is entirely unreasonable.”

The termination becomes effective March 20 and after that, TakeCare members will be treated as “self-pay” clients.

The Calvo transition report shows that Self Pay clients, [persons billed individually by GMH], were consistently the worst or next to worst in paying their hospital bills.

                                         PERCENTAGE OF GMH’s BILLING  PAID

Rank                    FY 2007                         FY 2008                    FY 2009                    FY 2010

1.                        TakeCare -75%               NetCare    -86%        Staywell     -72%         Netcare     -80% 

2.                        Selectcare -64%               TakeCare -78%        Selectcare   -71%         TakeCare  -73%

3.                        NetCare    -63%               Selectcare -63%       TakeCare   -70%          Staywell    -68%    

4.                        Self Pay    -53%               Staywell   -65%        Self Pay     -59%          Selectcare  -62%

5.                        Staywell    -39%               Self Pay   -49%        Netcare      -57%          Self Pay    -44%         

 

In light the date provided by GMH to the Calvo transition team, Senator Pangelinan has asked Senator Rodnriguez to call an oversight hearing so that the GMH board can “explain in detail their decision to terminate the TakeCare contract.”

 Senator Rodriguez’s chief of staff Clifton Herbert told PNC news Thursday afternoon that the Senator has been reviewing the issue for the past week. No decision has been made yet on whether or not to call for an oversight hearing.