Hawaii Pacific Medical referral has ended its service contract with a Manila hospital effective April 1, in view of the upcoming termination of its contract with the NMI Retirement Fund\u2019s group health insurance program.<\/p>\n
Group Health and Life Insurance program manager Dolores Moore said yesterday that HPMR\u2019s service agreement with Staywell for St. Luke\u2019s Hospital ended last weekend.<\/p>\n
As a result, she said that medical claims from Manila will have to be submitted directly to the Fund.<\/p>\n
\u201cThe claims that are not paid will be returned to us,\u201d said Moore.<\/p>\n
She said she is not aware of the number of GHI patients being treated in Manila. Normally, Manila gets only a handful of referral patients from the CNMI. Most GHI patients are referred to Guam, Hawaii, or the U.S. mainland. <\/p>\n
Meantime, HPMR will also be closing its office on Saipan by the end of this month.<\/p>\n
HPMR\u2019s contract with the Fund will expire on June 30 pursuant to the 90-day termination notice issued by the Fund on March 31.<\/p>\n
Based on their administration agreement, either party can issue a 90-day termination notice.<\/p>\n
A selection committee chaired by NMI Fund board member Steven King had selected Aetna as its third party administrator and Pharmacare as its prescription drugs benefits manager, replacing HPMR as the Fund\u2019s third party administrator.<\/p>\n
Both proposers will sign a three-year contract with GHI.<\/p>\n
AETNA\u2019S COST<\/p>\n
Sources claim that Aetna\u2019s fee is actually higher than HPMR.<\/p>\n
When asked, Moore said that \u201cit\u2019s about the same\u201d but she declined to cite figures, saying \u201cit has yet to be determined.\u201d<\/p>\n
HPMR charges Group Health Insurance members $8.75 each, according to Fund administrator Karl T. Reyes. This means that the Fund pays HPMR $93,625 a month for 10,700 members.<\/p>\n
Reyes said there is \u201congoing negotiation\u201d with Aetna on the fee.<\/p>\n
A source said that Aetna charges $32 per subscriber or per employee, totaling 4,032. If this is the figure, the Fund would have to pay Aetna some $129,000 a month.<\/p>\n
When asked, Reyes said he was not sure about Aetna\u2019s fees since he is not a member of the committee.<\/p>\n
He said that initial figures cited were $24, $32, or $33.<\/p>\n
\u201cThey are still negotiating,\u201d said Reyes.<\/p>\n
RE-ENROLLMENT<\/p>\n
Moore said that GHI will re-enroll members beginning may 15.<\/p>\n
\u201cMembers have to re-enroll. We\u2019ll have a re-enrolment period. We hope to get more members,\u201d she said.<\/p>\n
Moore expressed confidence that the transition period would be manageable.<\/p>\n
\u201c[It will] hopefully [be] smooth. We\u2019ll try and do it smoothly during the transition period,\u201d said Moore.<\/p>\n","protected":false},"excerpt":{"rendered":"
Hawaii Pacific Medical referral has ended its service contract with a Manila hospital effective April 1, in view of the upcoming termination of its contract with the NMI Retirement Fund\u2019s group health insurance program.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-99500","post","type-post","status-publish","format-standard","hentry","category-local-news"],"_links":{"self":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/posts\/99500","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/comments?post=99500"}],"version-history":[{"count":0,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/posts\/99500\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/media?parent=99500"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/categories?post=99500"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/tags?post=99500"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}