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Kaiser: Queen’s referrals largely unaffected by contract dispute

Hawaii’s two large health care companies haggling over billing

Kaiser Permanente sought to reassure Maui patients who have referrals to The Queen’s Health System facilities that their treatment would not be interrupted, after a contract between the two health care companies expired and Kaiser filed a lawsuit over billing issues.

Kaiser said in a statement on its website last week that Maui patients “generally will not have their course of treatment interrupted and will continue to receive treatment.”

The health care provider and insurer had been in ongoing negotiations with Queen’s since late 2017 to renew a hospital provider contract with Queen’s hospitals, including the flagship The Queen’s Medical Center on Oahu, Molokai General Hospital, and Queen’s facilities in West Oahu and North Hawaii Community Hospital on Hawaii island.

But Queen’s rejected multiple offers “for a fair and reasonable contract and has not given any indication of compromise from their original demands,” a Kaiser statement said. The contract expired on May 30.

Kaiser patients now are considered noncontract providers at Queen’s facilities. Queen’s Chief Financial Officer Michel Riccioni has said that Kaiser members would be responsible for claims not reimbursed 100 percent by the health plan.

Queen’s would not notify or seek clearance from Kaiser for services provided to members, who would be billed for any claim not reimbursed by Kaiser, Riccioni said.

Kaiser filed a lawsuit Wednesday over Queen’s attempt to collect the balance of charges “above what KP pays as usual and customary” from Kaiser members getting care at Queen’s facilities.

Kaiser member Susan McGreivy of Kihei said she received a letter from Kaiser recently that confirmed her scheduled digestive system treatment at Queen’s.

What alarmed her, though, was that the letter also said that if a patient has a referral to Queen’s and has not yet initiated care, Kaiser is “evaluating alternative options for care and, in consultation with you, will elect to either maintain the referral or to provide an equivalent alternative.”

McGreivy, who has been appreciative of her care with Kaiser, was concerned about follow-ups or future treatment at Queen’s.

“If I hadn’t been in the pipeline, what would they have done with me?” she asked Monday.

Kaiser spokeswoman Laura Lott said Monday that Kaiser is “committed to ensuring patients receive the care they need, in the most appropriate setting and maintain quality and continuity of care.”

If Kaiser members on Maui need specialty care not available on-island, Lott said these patients usually are sent to Kaiser’s Moanalua Medical Center on Oahu. Travel costs for Neighbor Island members who receive care at Moanalua are covered by Kaiser.

However, there are a “small number of very specific sub-specialties where QHS may be the only provider in the state,” Lott said. This includes “complex neurology patients who receive electroencephalograms” or video monitoring, she said. In addition, Queen’s is the only level one trauma center in Hawaii.

Lott said Kaiser members retain access to emergency and trauma services at all Queen’s hospitals. And, the specialized care at Queen’s will continue, though she wasn’t sure how many Maui patients access care at Queen’s.

As far as the lawsuit goes, Kaiser said in a statement on its website that “balance billing is an unfair practice that puts patients, who may already be dealing with serious and stressful health issues, in the middle of a contract dispute.”

Kaiser said it is committed to paying Queen’s fair rates for the care delivered to its members.

Minna Sugimoto, manager of corporate communications at The Queen’s Health Systems, did not respond Monday to specific questions about Kaiser insurance patients seeking nonemergency procedures at Queen’s but provided a statement.

“Queen’s is in the process of reviewing the lawsuit. While we do not comment on pending litigation, we can say that we will continue to ensure all patients who seek our help, regardless of insurance coverage, receive the highest quality of care,” the statement said.

“It has been our mission for 160 years to provide great clinical care for all the people of Hawaii, and we will continue to serve all patients, including Kaiser members, any time they need our services,” the statement said.

Lott said Kaiser is working hard to minimize the impacts of these issues on its members and that providers and care teams will work with patients to ensure they get the care they need.

If Kaiser Permanente members have questions about coverage or benefits, they should call Member Services at (800) 966-5955.

* The Associated Press contributed to this report. Melissa Tanji can be reached at mtanji@mauinews.com.