Health insurers maintain million-dollar debts with three of the main public hospitals

Representatives of three of the country’s main public hospitals stated yesterday, Wednesday, that companies health insurers they are owed $44.6 millionwhich threatens to put its operation and services to citizens at risk.

During a public hearing of the Senate Health Commission, it emerged, for example, that the accumulated debt of health insurers with the Dr. Antonio Ortiz University Pediatric Hospital amounts to $16.4 million.

In the case of the Adult University Hospital, the figure reaches $26.3 million, while the Dr. Ramon Ruiz Arnau University Hospital (HURRA) owes $1.9 millioncorresponding to the current fiscal year.

“Certainly, the inefficiency in the payment of insurance companies to hospitals and professionals, together with the financial problems of Puerto Rico, exacerbated by hurricanes, earthquakes and the pandemic, as well as the high cost of living, summarizes the critical state of the fiscal health of hospitals”he proposed Yesarel Pesanteassistant secretary of Medical and Nursing Services of the Department of Health.

For its part, Victor Diazexecutive director of the Pediatric Hospital, acknowledged that the million-dollar figure to be collected represents a concern for the administration and other medical institutions.

“It is something that worries us. Fortunately, unlike private hospitals, we have a General Fund budget that relieves us and, perhaps, we do not see an immediate impact. But, when we see such exorbitant numbers, like $16 million, we have to raise the flag and we have to warn that there is something that is not right.”said.

“The insurers that make up the Vital Plan “Of the government they do have debts with the Pediatric Hospital”Diaz reaffirmed, when asked by the president of the Senate, Jose Luis Dalmau.

Debts had to be settled last January

Dalmau questioned the existence of debts of $44.6 million, despite the fact that, in a circular letter, the Health Insurance Administration (ASES) requested that insurers that maintain contracts with government hospitals that, as of January 2023, “all claims and liquid debts (…) had to be satisfied immediately.”

To the panorama, Diaz added that, “as a general rule”, medical plans pay public hospitals a much lower rate than they maintain with private institutions. He opined that receiving payments on time and imposing fairer rates on medical plans would put public institutions in a “better position.”

Bianca Castroadministrator of the Adult University Hospital, recognized that the lack of payment from insurers is a determining factor in the current health services crisis and added the component of personnel recruitment and retention.

“It’s the insurers, it’s retaining health professionals, who leave for the United States every day because they offer better salaries, benefits that we cannot offer here”said Castro, agreeing that rates need to be adjusted to the current economic reality.

He explained that, of the $26 million outstanding, $6.8 million corresponds to a current debt, that is, it is within the 90-day period provided for in the “Prompt Payment Law.”

He added, incidentally, that the Adult University Hospital – which handles high-risk pregnancies – attended 100 more births, compared to last year, due to the closure of these rooms across the island..

The lawyer indicated that they make efforts to increase their own income and streamline billing with insurance companies. However, she acknowledged that the process results in a “constant struggle” not only to collect that debt, but to negotiate better rates. “Insurers, perhaps, do not pay on time or do not pay what is due, but we cannot afford not to treat the patient when they arrive in the emergency room”, he explained.

Regarding the level of claims, Castro said that, on average, between 15% and 20% of bills are denied for medical utilization. Meanwhile, approved invoices are not necessarily paid in full.

“There can be no system that works like this,” Dalmau replied.

The deponents suggested that a satisfactory regulation would be to require insurers to pay public hospitals a rate that is “at least” the same as the one they maintain with private ones. Likewise, they recommended amending the “Prompt Payment Law” so that it really works as a “deterrent.” for insurers.