TakeCare takes GovGuam health insurance protest to OPA

TakeCare health insurance (PNC file photo)

Guam – TakeCare Insurance has now taken its case to the Office of Public Accountability to appeal a GovGuam Health Insurance requirement that mandates inclusion of GRMC as an in-network provider.

The Department of Administration denied TakeCare’s protest, noting that inclusion of GRMC would provide for a “level playing field” and parity in price.

In his denial letter, Director Ed Birn also points out that GRMC is located in a more populated area of Guam.

“To require GovGuam employees to be admitted to only a single facility would incur a risk that the limited availability of beds would delay health services to subscribers and their dependents,” he said.

Burn also notes that contrary to TakeCare’s argument that the requirement violates procurement law, the same law is what allows DOA to require other terms like including Philippines, Hawaii and the U.S. mainland in a bidder’s provider network.

Interestingly though, DOA didn’t always agree with this notion. Back in March of last year, when the Legislature was floating around the idea of requiring all private hospitals in the RFP, DOA opposed the measure.

At the time, however, it was a different director leading DOA: Christine Baleto.

In her testimony she said the bill “violates the spirit and intent of the law as it would provide special recognition and treatment to the private hospital on Guam.”

Out of the four major health insurance carriers on Guam, TakeCare is the only agency without a contract with GRMC. And since the law was changed to allow for the choice option, TakeCare has consistently been included in the GovGuam Health Insurance contract.