GMH now accepting TakeCare health insurance members

TakeCare health insurance (PNC file photo)

The Guam Memorial Hospital Authority and TakeCare Insurance Company Inc., have reached an agreement concerning billings and payments.

On September 9, 2020, TakeCare paid the GMHA $1,728,638.63 as a good faith payment for claims and services provided between January 1, 2018, through December 31, 2019, as part of this agreement.

GMHA agreed to accept TakeCare members at GMH effective September 9, 2020, and bill TakeCare for services rendered at Guam Memorial Hospital for eligible TakeCare members.

Both parties agreed to an independent, third-party auditing firm, Ernst & Young, paid for by TakeCare, to reconcile the $17.4 million in alleged outstanding claims and $6.3 million payment made by TakeCare in 2017 to GMHA. If Ernst & Young determines that a credit is due to TakeCare, GMHA will apply it to TakeCare’s account. If Ernst & Young determines that payment is due to the GMHA, TakeCare will remit the payment within two weeks.

TakeCare will also pay the GMHA $1.50 million, payable in two equal installments, as good faith payment for claims on services provided between January 1 through March 11, 2020. The good faith payments are subject to reconciliation by Ernst & Young.

TakeCare Health Plan Administrator Arvin C. Lojo said: “We are pleased with the results of this agreement. Both parties negotiated and compromised in good faith. Hospital services provided by GMH to TakeCare members will be billed directly to TakeCare by GMH. TakeCare looks forward to the results of the reconciliation bringing this matter to final resolution while furthering our collaborative relationship with GMH. We also extend our gratitude to our valued employer groups and members for their continued support and trust in TakeCare.”

(TakeCare News Release)