Insurance companies said to owe hospital $6M
After accommodating insured patients to meet their needs, the Commonwealth Healthcare Corp. is now pushing health insurance companies to do their part and pay the hospital for services rendered.
“We want to maintain our services and be available but we also want to get paid. We weren’t able to do that in the past because we were behind in our billings and in our payment postings,” said CHCC CEO Esther Muña.
CHCC has now updated its billing records and that means their records are now current; this time, they want insurance companies to be current with their payments as well.
“Now that we are updated, we are basically saying that our records are valid and legitimate. These are not just numbers but actual claims. We are saying that these were provided for your members and health insurance companies must pay,” said Muña.
To date, three health insurance providers owe CHCC at least $2 million each, Muña said. These are TakeCare Health Plans, StayWell Saipan, Inc., and Calvo’s Insurance.
“What we have been doing recently is we’ve been closely monitoring the insurance companies and how they are performing. The system is showing a $2-million claim from each insurance company and we need it. Our vendors go after us so we need to go after insurance companies, too, to do their part,” Muña said.
CHCC has hired Tiffany Sablan as Revenue Cycle director and her hiring and other improvements in CHCC’s revenue cycle has resulted in updated financial processes in the hospital’s billing and collection system.
“The majority of the insurance claims are from the last two years. Some of them even goes back to 2012 but the reality is that majority of those claims are from the last two years. These should be collectible,” Muña said.
She said that CHCC needs to identify funding sources to be able to implement its plans to increase salaries, improve services, and hire more doctors for Saipan, Tinian, and Rota.
“As for the salary increase, we implemented some and the idea is, by October 1st, we are going to implement the salary scale that we submitted in our budget plan. We plan to improve our services, especially in the improvement of care and renovations of facilities. That is why we are more aggressive in collecting our claims,” Muña added.
Non-payment could push CHCC to get out of the insurances’ network.
“We don’t have contracts with them but we plan to have provider agreements with them. That has not been completed because some questions need answers and at the end of the day, there needs to be mutual agreement between CHCC and the health insurance providers,” she said.
According to the CHCC CEO, the Legislature plans to introduce a bill that is similar to Guam’s prompt payment law and this is welcome.
“Guam has a prompt payment law where the claims are billed by the Guam Memorial Hospital, that insurance companies have a certain time to ‘scrub it’ and basically say these are the bills that are clean so we have to pay the hospital or in our case, the CHCC.”
Pushing for payment from these health insurance companies is a way of providing service to patients who were attended to by CHCC and who are paying insurance premiums to get service.
“At CHCC, our utmost obligation is to serve our patients who are members of these health insurance providers and, that being so, it is their obligation to pay us,” Muña said.
MD: CHCC pushes for health insurance companies to pay