Up Front
Health Insurance Works
The compulsory Health Insurance law passeda little over two years which at the time was widely welcomedby the public, today appears to be producing feelings of ill willamong patients, health providers and the health insurance companies.
The problems are many, health practitionerscomplain. They say that they need to hire an office administratorjust to handle claims and that they have to check every card tosee if patients have reached their deductible.
Further, they say that the insurance companiestake too long to reimburse them for the patient care, and thatthere is no easy access to data from the insurance companies.
One medical facility is reported to be owedas much as CI$250,000 by one insurer.
"We all feel that the compulsory insurancelaw is a good thing; we all need it," stated one doctor whodid not wish to be identified. "But I can't provide an extraperson to chase the insurance company. Many times this becomesa back and forth event. It is a matter of economics and the doctorsfeel as if we are fighting a lost cause sometimes," he added.
Patients, on the other hand, say they arefeeling the pinch financially as well, with rising cost of insuranceand lowering of benefits. To further complicate the situation,most doctors are no longer willing to accept small claims.
"We don't like to get involved withsmall amounts," one medical centre executive confirmed. "Weprefer to take large claims only."
One general practitioner concurred, saying,"I don't accept most insurance cards. I will if I know theperson, so in the event the insurance company will not pay, thatperson will reimburse me. Most often my office will fill out theforms for the patients and let them submit the claims."
Up to press time, efforts to get a commentfrom insurer Colin Luke and Associates proved unsuccessful.
Ms. Linda Chapman of Cayman Insurance Centreexplained some of the problems that insurance companies are having."When the law was first passed, it appeared as if peoplewere using the insurance cards like credit cards. If they hada simple headache they would run to the doctor's office ratherthan try an aspirin. This is where the problem started."
Some in the medical community say they areirked by the billing procedures of some insurance companies.
"The laws state that a form shouldbe used. The insurance companies want us to invoice them. Thisis not what the law requires. We are more than willing to sendin an itemised list of procedures, if necessary. But when it wasa simple doctor's visit why can't we use the insurance form?"one doctor questioned.
Some other medical providers say the problemswith the insurance companies persist because the law "hasno teeth, " as there is no legal provision for insurancecompanies to be fined or have their licence suspended for latepayment.
In a recent statement, Minister of Health,the Hon. Linford Pierson cited the need "to look very seriouslyat delinquent insurance companies. It is our intention to dealwith this issue as speedily as possible," he promised.
Cayman Net News has learnt that the CaymanIslands Medical and Dental Society is lobbying for laws that wouldrequire insurance companies to pay within the standard 40-dayperiod that is accepted worldwide.
One insider did note that things are improving,with claims being processed faster by insurance companies.