Healthcare Officials Address Claim Denials and Revenue Collection Challenges in Guam

The 38th Guam Legislature convened on August 17, 2025, for a budget session focused on the fiscal year 2026 budget. The meeting addressed several key issues regarding healthcare funding and operational challenges faced by the Guam Memorial Hospital (GMH).

The session began with discussions on the hospital's ongoing struggles with insurance claim denials. Hospital representatives highlighted that a significant number of claims are being denied by insurance companies, which has created a backlog and slowed cash collections. The hospital is working to design a system to manage these denials more effectively and appeal them in a timely manner. The representatives noted that the process of appealing denials adds an administrative burden to staff, as they must submit comprehensive medical records with each claim, a requirement that differs from practices in many stateside insurance companies.

The conversation then shifted to the hospital's financial situation, with a focus on the various categories of accounts receivable. It was noted that third-party payers and Medicare present the best chances for collection, while self-pay accounts remain the most challenging. The representatives expressed concerns about the low reimbursement rates from Medicare and the lengthy process required to enroll patients in Medicaid, which often results in lost claims due to age limits on submissions.

Senator Perez raised the issue of the hospital's funding needs, indicating that GMH requires approximately $57 million more than what has been appropriated to meet its operational demands. The discussion also touched on the potential for new systems to streamline Medicaid enrollment, which could alleviate some of the financial pressures.

Senator Svendal Luhan acknowledged the immediate healthcare needs of patients at GMH, emphasizing that discussions about a new hospital do not address the urgent requirements of current patients. He inquired about the status of previously appropriated funds for a birthing center, seeking clarity on the availability of these resources.

The meeting concluded with a commitment to continue exploring revenue-generating opportunities and addressing the pressing financial challenges faced by GMH. The legislators expressed their intent to follow up on these discussions in future sessions, aiming to ensure that the hospital can meet its operational needs and provide essential services to the community.