SAIPAN Health Clinic and Island Medical Center will no longer honor the government’s health insurance beginning June 1, citing questionable contract provisions offered by the third party administrator contracted by the Retirement Fund.
Both clinics did not sign a contract with Hawaii Pacific Medical Referrals due to contract provisions they described as “unfair” and “disadvantageous” to them.
Dr. Vicente Aldan of Saipan Health Clinic said the government insurance owes the clinic about $200,000.
Art Moore, administrator of Island Island Medical Center, said the government-run Group Health and Life Insurance plan also owes the firm money.
All the other five private clinics—Pacific Medical Center, PacifiCare, Marianas Eye Institute, Marianas Medical Center and Saipan Seventh Day Adventist Clinic—recently signed the HPMR participating provider agreement.
These clinics, however, are also not being paid on time by the government insurance plan.
HPMR had been contracted by the Retirement Fund to perform utilization review services, pharmaceutical benefits management, coordination benefits, dispute resolution and arbitration in behalf of the government-run Group Health and Life Insurance plan.
Regina Ann C. Torres, operations manager of HPMR, said the Commonwealth Health Center did not sign a contract with HPMR, but was officially announced as a “participating provider” for the government insurance program.
“CHC will always be a provider. It’s always been HPMR’s policy to have a formal agreement with provider clinics, and to have provider networks,” Torres said.
GHLI owes CHC at least $27 million.
‘No fiduciary duty’
Aldan and Moore, in separate interviews, said HPMR claims it has no fiduciary responsibility to the Retirement Fund, the provider clinics and the patients with respect to any payment.
Aldan said HPMR does not guarantee payments to any clinic that provides services to patients with government insurance, which puts these clinics in a disadvantageous position.
“Saipan Health Clinic did not sign the contract with HPMR because of questionable provisions,” Aldan said.
Moore said certain provisions of the contract with HPMR “didn’t appear to be to our advantage.”
“Because of these disagreements, we elected not to sign the contract with HPMR,” Moore said.
Saipan Health Clinic and Island Medical Center said they will continue to provide medical services to patients with government insurance, provided they pay upfront.
Aldan said about 25 percent of Saipan Health Clinic’s patients have government insurance.
According to Moore, about 30 percent of Island Medical Center’s clients have government insurance.
Saipan Health Clinic has been honoring government insurance since 1990.
Earlier, Pacific Medical Center also decided not to honor GHLI or HPMR card due to non-payment.
After partial payment was promised, PMC requested reinstatement of the clinic as a provider for GHLI and HPMR members.
GHLI currently has over 10,000 members, including their dependents.
