Gov’t. seeks funding to pay health providers

Local officials are racing against time to come up with the much needed amount to settle its unpaid account with two health providers im Hawaii amid threats that the latter will no longer accept patients referred by government’s insurance group.

The NMI Retirement Fund’s health insurance owes Honolulu-based Straub Clinic & Hospital and Queen’s Medical Center $2 million and $1.8 million, respectively, for the services they have rendered over the years.

The two health providers have warned that they will refuse patients from the Northern Marianas unless the Fund’s health insurance immediately pays its debt.

But while the Fund is hoping to raise money to settle the account, the government’s health insurance has detected some discrepancies in the billings provided by Straub.

According to Dolores S. Moore, manager of Group Health & Life Trust Fund, her office has already sent back $1 million worth of billings to Straub after an evaluation showed that the Fund should not be charged for such services.
She said the Fund does not have any complaints on the amount billed by Queen’s Medical Center.

“We have just returned that amount they are claiming but we found out that we should not pay them because either the patients have exceeded the $50,000 maximum benefit or they are not covered by the insurance,” she added.

The Fund has already processed payment to Straub for the remaining amount the health insurance owes to the health provider but could not release the check for lack of funds.

While the Legislature is willing to provide an appropriation to help the government health insurance settle its financial obligation, the Fund must immediately hire a utilization reviewer to look into the medical billings to examine each health claims, said Rep. Malua Peter.

“We are in a crisis situation so we would like to help them settle the financial obligation.
We are obligated to pay for the services they have rendered but do we really owe them that amount? I will ask the leadership to support them by providing funding if they will hire a utilization reviewer to avoid this from happening again,” she said.

The Commonwealth Health Center is still sending patients to the two hospitals on medical referral without mentioning that they are members of the government health insurance. But the problem, Ms. Peter said, is that the Medical Referral Program may eventually run out of money even before the Fund could settle its account.

The board has already discussed the possibility of hiring a review utilization firm or a full time utilization reviewer in a move to efficiently manage all health claims of the members.

In 1999, the Fund spent an average of $400,000 a month in health claims of its members alone.

The skyrocketing cost of medical expenses led the CNMI Group Health Insurance Program to increase by 50 percent the premium contribution of its more than 5,000 members last Jan. 1, 2000.