CNMI UNABLE TO PAY MEDICAL INSURANCE BILLS

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By Gemma Q. Casas

SAIPAN, CNMI (Marianas Variety, March 29) - The Commonwealth of the Northern Mariana Islands’ Group Health Life Insurance Plan has been rejected in various hospitals in the U.S. due to its mounting arrears, forcing some retirees living in the states to pay for their own medical expenses.

Several retirees from Oregon and Hawaii called the Variety yesterday complaining that their insurance was being rejected by hospitals there.

Karl T. Reyes, the administrator of the Retirement Fund, which oversees the Group Health Life Insurance Plan, confirmed that some hospitals in the U.S. and even the Philippines are no longer accepting Commonwealth of the Northern Mariana Islands patients covered by the government’s Group Health Life Insurance Plan due to concerns over irregular payments.

"That’s true," said Reyes in a phone interview. "We cannot pay all the hospitals. Our priority is the medicine. If we don’t pay it, they will cut us off."

In the Northern Mariana Islands, patients under the Group Health Life Insurance Plan get their medicines from PHI through RX America.

Reyes said every month, the medicines of patients on island alone amount to about US$200,000, nearly half of what the government is currently able to pay Group Health Life Insurance Plan’s third-party health administrator, the Hawaii Pacific Medical Referrals.

Hawaii Pacific Medical Referrals is owed at least US$1 million as of this month. That bill covers payments to off-island participating hospitals and clinics serving Commonwealth of the Northern Mariana Islands patients.

The Commonwealth Health Center is separately owed approximately US$7 million, Reyes said.

Right now, Reyes said the Commonwealth of the Northern Mariana Islands government is paying Hawaii Pacific Medical Referrals only US$500,000 every month.

About US$200,000 of that is earmarked for the patients’ medicine, US$93,000 for Hawaii Pacific Medical Referrals’ fee as third-party administrator and the rest is sent to the hospitals and clinics that served them.

Reyes said Hawaii Pacific Medical Referrals is able to pay only about 20 to 30 off-island hospitals and clinics of the more than 200 that used to accept Commonwealth of the Northern Mariana Islands patients.

To maximize the Commonwealth of the Northern Mariana Islands’ meager resources, Reyes said, Hawaii Pacific Medical Referrals does the payments on a rotation basis.

For instance, Hawaii-based medical facilities will be paid this month, and next month it will be Oregon or California and so on.

A retired government employee from Oregon who called Variety said a significant amount of her pension check goes to her premium for the Group Health Life Insurance Plan. She is demanding an explanation why their health plan was rejected.

The woman said she has multiple illnesses and expects that her Group Health Life Insurance Plan coverage will cover part of her medical expenses.

She said other Commonwealth of the Northern Mariana Islands patients are facing similar situations in California, Hawaii, and Washington, D.C.

Reyes is advising patients who are experiencing problems with their government health insurance to contact Dolores Moore, the Group Health Life Insurance Plan director.

"They have to call Mrs. Moore and ask her about the hospitals or clinics that can accept them," he said.

The Fund’s phone numbers on Saipan are 670-322-3863 to 67.

The Fund administrator said Hawaii Pacific Medical Referrals should be paid at least US$800,000 a month.

However, he said the premiums collected from both the current and retired government employees are simply not enough to cover medical expenses.

He said the Fund actually ends up subsidizing the retirees’ premiums by as much as US$73,000 a month.

Most of the patients are suffering from complications from diabetes.

The Northern Marianas is ranked as among the areas around the world with the highest incidence of adult diabetes.

March 30, 2006

Marianas Variety: www.mvariety.com

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