NMIRF: Health providers will have to wait

NMI Retirement Fund Administrator Juan S. Torres yesterday maintained that the two health providers in Hawaii seeking more than $4 million in payment will have to wait for the availability of funds and until the time each billings submitted by the hospitals have been thoroughly evaluated.

Mr. Torres said an initial review of the accounts sent to the Fund showed that a huge amount billed to the Group Health & Life Insurance should not even be paid by the government’s health insurance. He noted that one patient’s hospital bills amounted to $300,000 when the member’s policy only allows for a reimbursement of $50,000.

“We are not saying that the claims are not real, but the issue here is who will pay for that? We are only obligated to pay a certain amount and not beyond the ones covered by the policy,” he added.

Demand letters sent to the NMI Retirement Fund’s health insurance revealed that it should pay to Honolulu-based Straub Clinic & Hospital and Queen’s Medical Center $2 million and $1.8 million, respectively.

But the Fund’s health insurance manager 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.
Straub has asked the Fund to give a deposit as a condition from now on before the hospital could attend to its health insurance members.

“If I have the funds, I will give a deposit, but I don’t have any,” said Mr. Torres.

In a move to solve the problem, the Fund has already issued a Request for Proposal for the hiring of a review utilization firm to efficiently manage all health claims of the members.

Mr. Camacho said the firm will be able to negotiate the best quality service and cost for the Fund which has been having difficulty coping with the huge cost of medical claims since it took over the government’s health insurance in June 1998.

One of the firms that submitted a proposal has offered to provide the Fund 20 percent discount on all medical services, including room and board, surgery and prescription drugs for patients.

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.

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