Why did the Guam Seventh-day Adventist Clinic terminate the contract with TakeCare?

We terminated the contract because we had a difference in business philosophies. What does that mean? It means that we have different beliefs and values in how we run our businesses, and the Adventist Clinic determined it was in our best interest to terminate the contract.

When does the contract with TakeCare end?

The Clinic’s contract with TakeCare for Medical, Eye & Pharmacy ends June 30, 2017. However, we will continue to provide covered services until December 31, 2017, unless TakeCare arranges for patients to transfer care to a TakeCare participating provider and provides us with written notice. After December 31, 2017, the Clinic will be considered out-of- network for TakeCare patients.

For Dental, the contract with TakeCare ends June 30, 2017. However, we will continue to provide covered services until July 31, 2017 at the latest. After July 31, the Clinic will be considered out-of-network for TakeCare patients.

Can we accept new patients with TakeCare Insurance?

Yes, as long as we inform them that we will be an out-of-network provider effective January 1, 2018.

Once we are considered an out-of-network provider, will patients have to pay up front and seek reimbursement or is our clinic still submitting the claims?

We will not be doing any direct billing once we are out-of-network, which is effective August 1, 2017 for Dental and January 1, 2018 for Medical, Eye & Pharmacy. So the patient will have to pay out of pocket, and then seek reimbursement directly from TakeCare.

For those TakeCare patients who still want to be seen here at the Clinic after December 31, 2017, how much does the patient pay for out of pocket expenses?

After December 31, 2017, the patient will be charged 100% of our self-pay rates.

Does the clinic still need to obtain prior authorization on behalf of the patient after December 31, 2017?

Since the patient will be paying out of pocket, it will be the patient’s responsibility to get documentation to or from TakeCare to ensure they are covered.

For Eye patients, can established patients still be seen for their annual eye exam or for acute eye problems if it falls in between June 30-December 31, 2017?

Yes.

For TakeCare Eye patients, will they still be able to receive the 10% discount on frames & lenses

Yes they will, as everything will remain the status quo until December 31, 2017.