GMHA announces TakeCare insurance will no longer be accepted

Residents insured by TakeCare Insurance Company will not be able to use the benefit at the Guam Memorial Hospital Authority effective Aug. 20.

In an Aug. 19 press release, GMHA officials said the island’s only public hospital is no longer accepting TakeCare insurance coverage. TakeCare members/subscribers who go to  GMH will have to pay for services as “self-pay” patients and then request reimbursement directly from TakeCare.

According to the press release, the decision follows “lengthy and repeated communications GMHA engaged in with TakeCare leadership over unadjudicated and uncontested or ‘clean’ claims that are past the 45-statuary deadline to pay from the date GMHA submitted to TakeCare Insurance.

The insurance company “continues to withhold payment for GMHA for the services GMHA rendered to TakeCare’s subscribers,” according to the release.

“As a consequence, GMHA is forced to make the unfortunate, but necessary decision that it can no longer accept TakeCare insurance,” according to the release. Officials also wrote that the lack of timely payments affects GMHA’s ability to meet the critical healthcare needs for all of Guam.

This isn’t the first time GMHA and TakeCare have been in this situation. For about five months in 2020, beginning in May, TakeCare subscribers were not able to use their insurance at GMHA. At that point, there was a dispute over what GMHA officials reported to be $12.6 million owed to the hospital.

Hospital and insurance company officials were able to reach an agreement in September 2020. According to a TakeCare press release, the company paid $1.7 million on Sept. 9, 2020, for claims and services provided from Jan. 1, 2018 to Dec. 31, 2019. Both parties also agreed to an independent third-party firm Ernst & Young, paid for by TakeCare, to reconcile the alleged outstanding claims. mbj