HPMR stops services in RP hospital

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’s group health insurance program.

Group Health and Life Insurance program manager Dolores Moore said yesterday that HPMR’s service agreement with Staywell for St. Luke’s Hospital ended last weekend.

As a result, she said that medical claims from Manila will have to be submitted directly to the Fund.

“The claims that are not paid will be returned to us,” said Moore.

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.

Meantime, HPMR will also be closing its office on Saipan by the end of this month.

HPMR’s contract with the Fund will expire on June 30 pursuant to the 90-day termination notice issued by the Fund on March 31.

Based on their administration agreement, either party can issue a 90-day termination notice.

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’s third party administrator.

Both proposers will sign a three-year contract with GHI.

AETNA’S COST

Sources claim that Aetna’s fee is actually higher than HPMR.

When asked, Moore said that “it’s about the same” but she declined to cite figures, saying “it has yet to be determined.”

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.

Reyes said there is “ongoing negotiation” with Aetna on the fee.

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.

When asked, Reyes said he was not sure about Aetna’s fees since he is not a member of the committee.

He said that initial figures cited were $24, $32, or $33.

“They are still negotiating,” said Reyes.

RE-ENROLLMENT

Moore said that GHI will re-enroll members beginning may 15.

“Members have to re-enroll. We’ll have a re-enrolment period. We hope to get more members,” she said.

Moore expressed confidence that the transition period would be manageable.

“[It will] hopefully [be] smooth. We’ll try and do it smoothly during the transition period,” said Moore.