HAGÅTÑA (The Guam Daily Post) — One of the biggest concerns of health care providers with regard to the self-insured program the government of Guam is in the midst of finalizing is the government’s history of not paying vendors in a timely manner.
During a public hearing on Bill 154-37 and an informational hearing on GovGuam self-insurance held Aug. 18, the issue of prompt payment arose.
During the hearing, an inquiry by Dr. Thomas Shieh, an OB-GYN who has owned a private practice on the island for 27 years, opened the door for Sen. Frank Blas Jr. to ask the Department of Administration, SelectCare and NetCare about responsibility.
“I need clarity here, if this was to go through, this insurance plan was to be put in place. Mr. Birn, you were quoted on Aug. 11 (in a) Guam Daily Post article by John O’Conner. It says that ‘DOA Director Edward Birn has publicly stated that GovGuam will not pay providers directly, but reimburse payments made by administrators,” Blas quoted.
The senator went on to question SelectCare, which has been selected as the third-party administrator for the medical portion of the GovGuam self-insurance plan for fiscal 2024, whether the statement was how the company understood the agreement. Frank Campillo, SelectCare Plan administrator, said that wasn’t the understanding.
“We will cut the checks and the funds would be obtained from the account that the government of Guam sets up,” Campillo said, as he noted that his response cited in the story was “lost in translation” because of his accent.
Blas’ question goes toward the concern raised by Shieh on who would be responsible for ensuring prompt payment to health care providers, as mandated by Public Law 25-189.
“If that were the case, who is responsible, who is liable for the 12% that could be charged for not paying the bill after 45 days under prompt payment?” Blas asked.
Public Law 25-189 was established in 2001 and set the prompt payment requirements for health care and health insurance claims. According to the law, a rate of 12% interest would accrue “per annum as damages for money owed by a Health Plan administrator for payment of a Clean Claim or portion thereof, that exceeds the applicable reimbursement time limitations” under the law, “including applicable costs for collecting past due payments.”
But according to Campillo, the issue of liability had yet to be sorted out.
“It’s an interesting question and I think it’s one that we still need to review as (to) what the language for that prompt payment reads,” Campillo said.
During the hearing, it was noted that under the self-insurance plan, GovGuam is the insurer and SelectCare and NetCare are the third-party administrators.
Thomas Shieh
