Letter to Our Members – June 15, 2017

June 15th, 2017


Media Contact:

Kyla Aquino

(671) 646-6956


June 16, 2017

TakeCare responds to allegations of GRMC Claims

(Tamuning, GU) – TakeCare has released a letter to its members responding to GRMC’s allegations on outstanding claims. The content of the letter may be seen below.

“Dear TakeCare Member:

TakeCare is an insurance company with over 40 years of experience in facilitating quality medical care for its Members. As part of this process, TakeCare regularly enters into agreements with leading US and internationally accredited hospitals, including hospitals in Hawaii, the U.S. mainland and the Philippines, and always does its best to negotiate reasonable rates for its Members.

On Guam, TakeCare has a long-standing relationship with Guam Memorial Hospital (GMH). However, TakeCare does not have an agreement with Guam Regional Medical City (GRMC) because GRMC’s rates for services are substantially higher for equivalent services at GMH. For example, the daily room rate at GMH is approximately $600, while a daily GRMC rate is approximately $2,400. GRMC’s rates are an astounding 4 times higher than GMH!

If TakeCare agreed to pay GRMC’s excessive rates, the increased cost of care would simply be passed on to TakeCare Members by increased premiums. TakeCare, at the request of its employer groups, has offered to extend coverage for services at GRMC via a benefit rider with a corresponding additional premium adjustment. In the end, TakeCare’s customers have decided to forgo such GRMC coverage. In short, TakeCare’s customers clearly see no value in having access to GRMC and the resulting higher costs.

Recent media reports generated by GRMC falsely claim that TakeCare owes GRMC millions of dollars for care provided to TakeCare Members. This is simply not true. GRMC admits it does NOT even have an agreement with TakeCare. Without an agreement, GRMC is not a part of TakeCare’s provider network, and GRMC does not have the contractual right to bill TakeCare for services it provides to TakeCare Members. Therefore, it is impossible for TakeCare to owe money to GRMC.

Even though GRMC does not have an agreement with TakeCare, we have always reimbursed members at the same usual, customary rate paid to GMH for bona fide emergency services subject to the terms of its policies. TakeCare treats GRMC consistent with industry practices when bona fide emergency services are required, whether on- or off-island, at non-participating hospitals. Our research shows that only a small fraction of the alleged outstanding claims are for bona fide emergency services GRMC provided to TakeCare Members.

In addition to charging unreasonable rates, GRMC, through its own omission, has also failed to submit many bills for services to its patients, including TakeCare Members, in a timely manner as required by law. The Health Care Prompt Payment Act of 2000 (Title 10 Guam Code Annotated §§ 9901-9908), requires that GRMC submit accurate claims within 90 days from the date that health care services were provided. Under most circumstances, claims not submitted within 90 days from the date of services cannot be collected from either a patient or his/her insurer. Consequently, GRMC’s threat to send stale bills to TakeCare’s Members may be in violation of law, depending on when services were provided.

TakeCare has made several good faith efforts to settle disputed claims and to negotiate reasonable rates with GRMC so that it can be included in its provider network. To date, these efforts have not been successful because of the unreasonable positions taken by GRMC. GRMC’s misrepresentations about TakeCare in the media, and threats to TakeCare Members, are just the latest maneuvers designed to bully TakeCare into an unfair agreement which would not be in the best interest of its Members. TakeCare will continue to insist upon reasonable rates before any agreement can be reached with GRMC.

TakeCare recommends that any Member receiving a bill from GRMC to contact TakeCare Customer Service at 647-3526 for information and assistance. Customer Service will help explain Members’ rights and responsibilities under its health plans as well as help to review GRMC’s billings for accuracy. Members may also wish to consult with legal counsel regarding their rights against GRMC for trying to collect on untimely claims that may be barred by Guam law.”

To view the full letter, please click on the link below.

TakeCare GRMC Ad_Full Page_vf