Страховка TakeCare прекращает работу с городским медицинским центром Гуама, пациенты станут платить за услуги самостоятельно

Guam Regional Medical City will no longer be an in-network provider for TakeCare Insurance on Wednesday, which means those with TakeCare insurance will be treated as self-paying patients in most circumstances if they are treated at the Dededo hospital. GRMC on June 9 sent a notice to TakeCare of its intent to terminate the Provider Services Agreement between GRMC and TakeCare. Effective Wednesday, the Provider Services Agreement is terminated and GRMC will no longer be an in-network provider for TakeCare. It means that on and after Sept. 9 TakeCare members who receive medical treatment or other services at GRMC will generally be treated as self-paying patients and will be personally responsible for payment for such services, the hospital said. Arvin Lojo, health plan administrator for TakeCare Insurance, wrote in a Sept. 3 letter to members that the company has continued working in good faith with GRMC to resolve the issue and keep GRMC as part of TakeCare’s provider network. “Unfortunately, to date we have not been able to reach an agreement that responsibly protects our members, and employer group’s plan affordability, and long-term financial stability. TakeCare must make decisions that place the interests of employer groups and members first,” Lojo wrote. He said that TakeCare’s role is to help protect access to quality care while preserving plan value, affordability, and the sustainability of coverage for the groups it serves. “TakeCare is prepared to support you through this transition with clear communication, practical guidance, and continued access to in-network care options,” Lojo wrote. TakeCare will continue to review, process, and pay valid claims in accordance with applicable benefit plans, contractual provisions, and regulatory requirements, he wrote. “This careful stewardship helps protect your access to care, the value of your benefits, and the long-term stability of your health plan,” he added. He said they recognize some members may currently receive care at GRMC or have upcoming services scheduled. TakeCare will help these members understand their options and take practical steps to help avoid care disruptions whenever possible. Those who have questions or need support, can contact TakeCare Customer Service: Guam: (671) 647-3526 Toll-Free: 1 (877) 757-6418 Email: [email protected] GRMC in its notice said patients with TakeCare have rights to continue care under the No Suprises Act. TakeCare is required by law to notify each member who is a continuing care patient of the termination of the Provider Services Agreement, and of the member’s right to elect to have continued benefits with respect to course of treatment from GRMC for a limited time while they transfer care to an in-network provider. A “continuing care patient” is an individual who is: Undergoing a course of treatment for a serious and complex condition from GRMC; Undergoing a course of institutional or inpatient care from GRMC; Scheduled to undergo nonelective surgery from GRMC, including receipt of postoperative care from GRMC with respect to such a surgery; Pregnant and undergoing a course of treatment for the pregnancy from GRMC; or Is or was determined to be terminally ill and is receiving treatment for such illness from GRMC. Patients who believe they qualify, but have not yet sent a written notice to TakeCare of their election should contact TakeCare immediately, GRMC said. If a patient requires emergency care at GRMC, they will be responsible for applicable, in-network member cost-sharing amounts (such as copayments, coinsurance, and deductibles) for emergency services at GRMC, and TakeCare remains responsible for the balance, subject to plan eligibility and benefits. TakeCare said GRMC can still be used for emergencies, but the patient or a representative must notify TakeCare within 48 hours of receiving emergency care at GRMC to ensure coverage. No prior authorization is needed for emergency care. Once stabilized, GRMC is required to transfer the patient to an in-network provider for further care. Any inpatient admission at GRMC after stabilization requires prior authorization for coverage, TakeCare said, If admitted into GRMC, an authorized representative should contact TakeCare as soon as possible. Coverage for hospital expenses at GRMC depends on prior authorization and approval. A patient is responsible for their plan’s member share if services are approved. A bona fide emergency is a sudden, unexpected illness or injury that requires immediate care to prevent serious health risks, such as severe pain, risk to life, or serious impairment to bodily functions, TakeCare said. For non-emergencies, use in-network urgent care centers like FHP Urgent Care, which offers extended hours and a range of services for minor illnesses and injuries. More from this section