STARTING on May 10, patients with government health insurance coverage will no longer be accepted by Pacific Medical Center unless they pay upfront.
Consistent delays in payments and an outstanding debt of over $200,000 forced PMC to stop honoring Group Health and Life Insurance coverage or Hawaii Pacific Medical Referrals insurance cards, PMC said.
PMC has been accepting GHLI members since 1994.
But Dr. Ahmad Al-Alou, PMC medical director, said it is “unfair” to continue providing medical services to GHLI members without getting paid by the government.
“When they do make payments, it only covers the services we provided them eight or six months ago,” he said.
“It’s hard for PMC to survive without clients enrolled in the government insurance program, but it would be much harder for us to continue accepting them without getting paid,” Al-Alou told Variety.
Sixty to 70 percent of PMC’s clients are GHLI or HPMR card holders, he added.
Al-Alou said since 1994, the government has been delaying its payments to PMC.
“It got worse in the last three years,” he said, adding that the government’s debt now stands at over $200,000.
Vicente C. Camacho, chairman of the Retirement Fund’s board of trustees, could not comment on this amount.
He, however, said HPMR was reviewing PMC’s billing.
PMC is also set to reduce the size of its workforce because of the expected sharp decline in the number of its clients as a result of its decision to stop honoring government insurance, Al-Alou said.
‘Reconsider’
Sen. Ramon S. Guerrero, American Reform-Saipan, said it would be the government’s loss if PMC stops providing medical services to GHLI members.
The senator said Al-Alou is a competent provider of medical services.
Guerrero requested Al-Alou to reconsider his decision.
He also urged the Retirement Fund to immediately resolve the issue on insurance payments.
“Why, Mr. Chairman, has GHLI failed to address the concerns of PMC and other medical clinics regarding government health insurance plans and services, fee schedule and the unreasonable delays in payment?” Guerrero asked Camacho in an April 10 letter.
The senator said the health of the people of the CNMI “is not to be taken lightly” and that he “will not tolerate the displacement of government employees who are GHLI members.”
The GHLI program, which is under the Retirement Fund, is now being administered by HPMR.
According to Camacho, the government is on its way to addressing payment problems, and is asking for PMC’s patience.
“That’s PMC’s own decision. All we want is patience. It would be PMC’s loss if they stop accepting patients with government health insurance coverage,” Camacho told Variety.
He expressed hope that the matter would be resolved soon.
Mixed reactions
The Retirement Fund also issued yesterday a one-page public announcement, notifying all members of GHLI and HPMR insurance card holders that the board of trustees had “excluded” PMC as one of its local providers.
“Those that elect to be treated or diagnosed by PMC will have to pay upfront and HPMR will reimburse them,” the announcement said.
It added, “This shall be effective on May 10, and shall remain indefinite until the board of trustees so decide.”
It is not only PMC, however, that has a problem collecting payments from the government health insurance program.
Officials from other private clinics, who refused to be identified, said they, too, were having a hard time getting payments for the services they render to GHLI members.
“All of us have the same problem,” said one of the doctors interviewed.
Rep. Benjamin Seman, R-Saipan and chairman of the House Committee on Health and Welfare, called for a meeting among officials of private health care providers, HPMR, the Retirement Fund and the Department of Finance “in order to discuss issues with regard to health insurance payments.”
The meeting is set for April 18.
Camacho, in an April 11 letter to Seman, requested that the meeting be held on April 30 so that all parties will be able to participate.
House Committee on Ways and Means Chairman Stanley Torres, R-Saipan, said other private clinics will have more clients due to PMC’s decision.
“I feel sorry for PMC. Its decision was made at a time when the processing of the payment from GHLI has improved,” said Torres.
