Legal woes loom over unpaid bills

The legal counsel of the Northern Mariana Islands Retirement Fund yesterday warned the Board of Trustees that they may face a wrongful death claims due to the continuous refusal by private health providers to treat patients who are members of the CNMI Group Health Life Insurance Program.

NMIRF has appealed to Gov. Pedro P. Tenorio for assistance in securing some $6 million in funding so that it can retire its debt and set up the GHLI trust fund which will pave the way for the hiring of a review utilization firm.

During its monthly meeting, the board was informed that patients were being turned away by the health providers and surgeries are being canceled due to the non-payment of debt by the CNMI health insurance.

Representatives of the Fund and the Medical Referral Program met recently to reconcile the billings of the different health providers which the two government agencies must settle.

The Fund said GHLI will only shoulder a certain amount of the medical bill based on the insurance policy of its members thus, the Medical Referral Program should be made to pay the rest of the amount.

Two health providers, Honolulu-based Straub Clinic & Hospital and Queen’s Medical Center, have demanded $4 million in payment from the Fund. The two private health providers claim that the unpaid bills of the Fund was since 1998.

Due to failure of the Fund to settle its financial obligation, the health providers are now asking members of the CNMI government health insurance to pay in cash before they are given medical attention.

NMIRF Board Chair Vicente C. Camacho said students abroad as well as local residents traveling have been having difficulty to get medical treatment due to refusal by the private health providers to honor the CNMI-government issued card as a result of untimely payments made for services rendered to eligible members.

According to records, the liability of the government health insurance to the health providers dates as far back as 1992 but the Fund will only be responsible in taking care of the billings made in 1996, the year it took over the management of the health insurance.

The 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.

As a result of inconsistencies in the billings, the Fund has hired a Honolulu-based company to study the feasibility of turning over a major portion of the GHLIP functions for them to manage.

The board has chosen the Hawaii Management Alliance Association to examine all medical billings, settle dispute, arbitrate and ensure that patients are treated for what they are diagnosed. (Lindablue F. Romero)