Guam – GMH Attorney Tom Fisher told PNC News today that the reason why GMH terminated TakeCare’s contract was because of its un-reasonable denial of coverage.
His remarks followed the release of a subscriber letter from TakeCare Monday telling its subscribers that they had recently advanced $700-thousand dollars to Guam Memorial Hospital “to help them meet payroll and other financial obligations.”
According to the TakeCare letter to subscribers, the $700-thousand dollars in payments was made over “the past several months, in response to requests by the GMHA administration.”
And, the letter from Chief Operating Officer Jeff Larsen, states that the $700-thousand dollars paid to GMH was “in addition to the usual bi-weekly payments TakeCare submits to GMHA for clean claims on behalf of its members under the Direct Payment Agreement.”
TakCare’s subscriber letter claims ignorance of the reason for the termination stating that the GMH termination notice does not explain why and that TakeCare Management is working with GMH “to try and understand why the board would seek to terminate the agreement with TakeCare, and to determine what steps can be taken to avoid the termination.”
But Fisher told PNC News “too frequently we have have had TakeCare customers presenting themselves at the hospital for treatment and they are treated and TakeCare refuses to pay for that treatment. As a result, the hospital and ultimately the Guam taxpayer end up paying for the treatment.”
Fisher cited one case last year in which a person came to the hospital with a broken limp and that individual was not seen until the following day because the orthopedic surgeon was not available until then. And TakeCare, says Fisher, refused to cover the 1st day of hospital care for the patient.
“Essentially the Guam taxpayer had to cover that,” said Fisher.
The termination of TakeCare’s contract with the hospital becomes effective march 20, unless the company can convince the hospital to reverse its decision.
TakeCare has assured its subscribers that their medical bills at the hospital will be covered.