Accessing your TakeCare benefits on-island

By Rodney “RJ” Ricarte

Your TakeCare GCA Employee Health Benefits travel with you around the island to access the medical procedures needed by you or your family.

In order to create a smoother, less stressful process to access your health benefits, TakeCare has processes in place to review requests by providers for authorization of health care services for members who are receiving on-island care.

I’m not able to describe every policy in detail, due to the space limitations of this column, so I will provide a general outline. In addition to the member handbook http://tiny.cc/TakeCareMemberHandbook , please refer to the schedule of benefits and provider directory for a more thorough description of covered benefits and plan information. I also advise to call ahead to TakeCare Customer Service Department in Guam (671) 647-3526 or toll free 1 (877) 757-6418, obtain information about your benefits. Non-urgent inquiries should be emailed to customerservice@takecareasia.com. For pre-authorization inquiries or requests, please call TakeCare Medical Referral Services at (671) 300-5995 or email tc.mrs@takecareasia.com.

When do you need to contact TakeCare for on-island medical referral?

A list of health care services requiring pre-authorization is found in the Member Handbook. These services include inpatient/hospitalization and related services including all scheduled inpatient admissions, including but not limited to surgeries, Cesarean sections, and admission resulting from an emergency. Outpatient, in-office and related services including outpatient surgical procedures, excluding maternity care. Outpatient services/treatment including Cancer care (chemotherapy/radiation therapy), self-injectables, and sleep studies.

Medical referrals are also required for radiological/nuclear/magnetic/resonance scans including MRI/MRA, CT Scan, Spiral CT Scan and bone density studies. Appliance/prosthetics/durable medical equipment (DME) are also covered with proper authorization.

Prior authorization requires the prior authorization form with appropriate ICD 10 and CPT Code, the referral form from your medical provider, and complete supporting medical records (doctor notes, imaging report, pathology report, etc).

When you’re planning on-island hospitalization or procedures, please make sure your provider contacts TakeCare for pre-authorization of services. Doing so will provide you additional peace of mind as you receive your health care benefits. It is also very important to follow up with your medical provider for the proper paperwork submission to avoid any delays.

Rodney “RJ” Ricarte is the TakeCare account executive for GCA. He can be contacted at (671) 487-7121 or rodney.ricarte@takecareasia.com.