NMIRF says some GHLI members turned away by hospitals

Amid reports that health providers in Hawaii have turned down some members of the Government Health and Life Insurance for treatment, the Northern Mariana Islands Retirement Fund board will meet with Gov. Pedro P. Tenorio in a last ditch effort to seek $6 million in funding to retire its debt and hire a review utilization firm.

“We are concerned with the situation because we have received reports that some members of the government health insurance have been denied service by health providers so this is a difficult situation that must be resolved,” said Mr. Camacho.

Some members were surprised to find out that the clinic or hospital they visited in Hawaii demanded immediate payment as they were also told to seek reimbursement later with GHLI for their medical expenses.

Some 297 health providers, majority of which are from Hawaii, have demanded payment totaling $5,087,195 from NMIRF.

The Legislature has already pledged to help NMIRF to provide funding provided it will hire a review utilization firm to ensure that the government health insurance is properly billed by the health providers.

Rep. Malua Peter, chair of the House Committee on Health and Welfare, has met with the NMIRF board members and told them that the Legislature has been identifying possible sources of funds to help the Fund get out of the difficult situation.

The board has approved in principle the hiring of Hawaii Management Alliance Association which will not only provide utilization review services but its appointment will lead to the privatization of the government health insurance.

However, the hiring of HMAA would need close to $800,000 to establish a revolving account, a trust fund and payment of set up fee.

“The ball is now in their court. We have already met the requirement they have imposed so we are just waiting for the money,” said Mr. Camacho.

HMAA will be able to get 20 to 50 percent discount to some 30-member hospitals and clinics. The company has in-house doctors who will analyze the billings and a pharmaceutical benefits manager who monitors the prices of medicine.

Operation of the government health and life insurance was turned over to NMIRF in June 1996 without providing any funding which left the Fund without any choice but to settle its liabilities.

The privatization of the operations of the government health insurance may result in the removal of a number of employees in GHLI since much of the work will be taken over by HMAA.

However, the Hawaii-based company has expressed willingness to hire some of the employees since it will establish an office in Saipan once the contract is signed.