CHC stops accepting TakeCare

The Commonwealth Healthcare Corp. and all facilities within the corporation has stopped accepting TakeCare Insurance effective yesterday.

The suspension came about after TakeCare Insurance declared that CHCC is not a participating provider in TakeCare’s provider network.

CHCC CEO Esther Muña characterized this a “sudden claim by TakeCare” and described it as “a weak attempt” to evade payment of arrears to the hospital.

“We have been trying to work with them for weeks to have the bills in the hospital get settled and paid. We have offered prompt payment discounts, provided many deadlines in order for them to compy, and initiated work settlements so both of us can move forward. Despite that, they kept dragging and delaying the process,” said Muña.

She said that TakeCare representatives have denied legitimate and documented claims, saying some claims are inaccurate and even went as far as saying that the claims bears the wrong text I.D. numbers.

“We recognize that all of those reasons are delaying tactics,” Muña added.

In a statement last night, TakeCare announced the completion of reconciliation of the CHCC’s claims from 2012 to June 30, 2017, that were submitted in June 2017.

“As of today, TakeCare has found that there is still an unapplied balance of $226,653.50 from the original advance of $1 million made to CHCC. As this balance is considered an excess payment to [CHC], TakeCare does not owe any further payments for historical claims,” the statement added.

TakeCare said it has received notification that CHC “will no longer serve as a network provider to patients with TakeCare Insurance.”

“TakeCare would like to make clear, despite CHC sending bills for services rendered directly to TakeCare, TakeCare members have always been self-pay patients at CHC as both parties have not entered into a provider service agreement.

“However, as a professional courtesy and as a matter of convenience for CHC, TakeCare has customarily accepted billings from CHC for covered services rendered to its members, and made payment to CHC subject to policy limitations and the benefit terms of its policies. 

“It is our sincere hope that CHC will continue to work with TakeCare to address the claims process, including working on terms of a Direct Payer Agreement,” the statement said.

In an interview last month, Muña said the majority of the insurance claims from different insurance companies recognized by CHCC are from the last two years.

Some of them even goes as far back to 2012 but the reality is that majority of those claims, Muña said, are from the last two years and are collectible.

Last August, CHCC hired Tiffany Sablan as Revenue Cycle director and her hiring and other improvements in CHCC’s revenue cycle has resulted in updated financial processes in the hospital’s billing and collection system.

To date, TakeCare insurance owes CHCC a total of $2.9 million. Last month, TakeCare gave CHCC a $1 million good-faith payment to allow both organizations to reconcile outstanding claims and to provide no disruption in services to TakeCare members.

According to Muña, the $1 million payment and the negotiations that occurred are all indicators that TakeCare and CHCC had a working relationship.

“In fact, there was a letter signed by all insurance companies including TakeCare in 2013 when CEO Juan Babauta was seated, agreeing to the health plans outlined by CHCC, which included room rates, operating room charges, CPT procedures, and for TakeCare now to say that CHCC is not a participating provider in their network is upsetting.” Muña said.

TakeCare Insurance said their members are now self-pay patients. Currently, TakeCare’s health plans have over 30,000 members in the CNMI.

CHCC continues to provide healthcare to TakeCare insurance members, but they will be responsible to pay in full upfront.