Bermuda’s elimination in 2012 of upfront payments for healthcare was viewed with unease by many doctors and dentists, but the practice is said to be working well.

As the deadline for the new system loomed, insurers and healthcare providers felt rushed into electronic payments, while service providers were unsure if they would get paid.

More than two years on, Tawana Wedderburn, the Bermuda Health Council’s health regulation director, said that “most definitely, the system is working very well”.

“It doesn’t mean that we are not without our challenges,” she added.

“One is being able to confirm that someone has insurance coverage and then confirming the nature of that coverage.”

Certain types of providers, listed on the Council’s website, are still entitled to charge upfront as they fall under special circumstances.

“There is another piece of the puzzle which relates to patient education,” Ms Wedderburn said. “Many don’t understand the distinction between a co-pay and an upfront payment.

“In the context of some other examples, we have had concerns in the community around ‘is this $100 a co-payment or an upfront payment’. It’s really making sure we clarify a co-payment and what’s an upfront payment.

“We have had a number of patients who have reached out thinking that they were charged upfront when in fact it was just a large co-payment.

“We have had people who have reached out to us about medical appliances. Those are excluded under the Act, such as eye glasses or tooth crowns.

“We have issued warnings. These cases are so few that we have not really had to do anything more.

“When we have reached out to the providers more often than not it’s been a misunderstanding.”

The Council has not seen any recent complaints about the new arrangement, she said.

“We average about one enquiry per month where someone may call and say ‘is this an upfront payment?’ and we’ve issued about two warnings,” Ms Wedderburn said.

The regulations give the health council authority to charge a $500 fine for each contravention of the regulations.

According to Jennifer Attride-Stirling, CEO of the Council, evidence has been presented to the watchdog on several occasions — but she characterised them as “one-offs”.

“Once it’s investigated more carefully, we find that the high bill that upset the patient was only the co-payment and the insurer was billed for a more significant portion,” Ms Attride-Stirling said. “We have not had to charge a fine to anyone as yet.”

She cautioned that some complaints may have gone unreported to the authority.

The Bermuda Health Council estimates that 90 per cent of the Island’s population has health insurance, although she said “a large proportion” lack a comprehensive policy covering their healthcare costs.