Guam Hospital Proposes Mandatory Down Payment

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Day services may require $200 plus 30% claim estimate

By Joy White

HAGÅTÑA, Guam (Marianas Variety Guam, March 20, 2013) – Guam Memorial Hospital (GMH) is proposing to require patients to pay a mandatory down payment of $200 plus 30 percent of the estimated claim for that day’s services after treatment.

The other proposal is to require patients to pay all of the estimated balance due per insurance company information.

GMH Chief Financial Officer Alan Ulrich and representatives from insurance companies on Guam met for a working session last night to discuss proposed new payment methods in an effort to improve the collection system at the hospital.

Insurers brought up concerns that the largest populations of patients who go to GMH are those under Medicaid and the Medically Indigent Program, along with the uninsured, who represent the group least likely to be able to have money for a down payment.

Currently, GMH allows patients to be discharged after treatment without leaving a down payment or paying any minimal amount they can afford.

"It really comes back to the whole paradigm that we’re operating in – where the self-insured, the uninsured and the low-income are seeking care here at GMH. And if that’s because there are no alternatives in the community, I don’t know that," Ulrich said.

Ulrich is referring to the belief that GMH is unable to collect any outstanding debts, which he hopes to combat with new initiatives.

He said the new fees would cause patients to evaluate where they’re seeking care, because the fees to seek primary care or urgent care may be less than what GMH will charge.

Ulrich pointed out that the law states the hospital is required to provide emergency care to patients, regardless of insurance coverage.

However, according to data collected by the hospital, 80 percent of patients visiting the emergency department are discharged the same day. Only 18 percent are admitted.

The proposed charges are not set in stone, however. Ulrich sought the insurers’ opinions on what amounts would be fair, as he has only been at the hospital for three months.


Future initiatives include an amnesty period, in which patients with outstanding debts can pay half of what they owe. This may begin once agreement has been made on the new fees, hiring a collection agency, and computerizing records.

In addition, GMH is proposing an incentive for the self-paying patients – a 30 percent discount for patients and guarantors who can pay on the date of services and a 15 percent discount to those who submit a financial disclosure statement.

Besides increasing collection efforts and improving billing and collections, GMH is seeking to improve patient registration to ensure adequate information is collected about patients and guarantors.

Follow-ups on outstanding debts will occur on a more regular basis, Ulrich said.

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