Doctors pledged yesterday to continue with hospital procedures for as long as possible although they are no longer being re-imbursed by local insurance companies and are legally prevented from billing patients directly.

But the very future of Bermuda healthcare is in jeopardy, they claimed, as they are uncertain how long they can continue without money flowing in.

A court injunction served on doctors late Monday by insurers Somers Isles and BF&M halted the practice of billing patients for medical procedures directly while doctors and insurers continue to battle without a fee schedule for services.

Doctors now say they are in a complete "state of confusion" over how to proceed.

"The insurance companies have said that they will not reimburse the doctors at the Bermuda Relative Value Schedule (BRVS), which is the most recently approved ratified fee schedule, and the court order prevents them from using the full Current Procedural Terminology (CPT) code book and from billing any insured patient directly," a joint statement from the Bermuda Medical Society (BMS) and Bermuda Medical Association (BMA) said.

"And it is not clear which procedures the insurance companies will cover under their limited new benefits policy."

The four-month long health insurance battle has left doctors uncertain how long they will be able to continue to operate without income and there seems to be no end in sight.

"This injunction...has really hijacked Bermuda's health care system and set us back several months," BMA president Dr. Jonathan Murray said. "It has left the doctors in a state of confusion about how to bill the patients - including Government employees and those insured by Colonial - for their hospital procedures, as we don't know which codes to use for billing."

Dr. Murray continued: "Yesterday we received a letter from the insurance companies' lawyers saying that we can use the CPT codes, however, because of the court order that Somers Isles and BF&M obtained, we must abide by that which says that we are `restrained from implementing the adoption of the entire CPT code book'. It is quite bizarre."

The doctors said they are in meetings with their lawyers on how to proceed with billing for hospital procedures while complying with the court order.

And Dr. Murray said it may be months before the injunction is lifted.

"This impasse has been going on for over four months and it will take months for the injunction to be lifted," he said. "It makes it tough to run a practice when some doctors have not been paid for so long and it is now difficult to predict the future of healthcare in Bermuda."

BMS president Dr. Steven Trott was equally gloomy.

"We will continue to provide medical service as long as possible," he said. "However, without a regular income we are not sure how long we can continue.

Dr. Trott said it should be a medical professional's decision how to proceed with patient treatment not an insurance company's.

"This tactic used by Somers Isles and BF&M is typical of restricted healthcare that we have seen in other countries and it saddens us to think that Bermuda's healthcare system may be heading in that direction," he said.

"Our biggest concern is being able to provide the best quality healthcare to a patient. It is up to a qualified medical practitioner to decide which procedure is necessary for a patient.

"We shouldn't have to worry about what is and isn't covered under their medical insurance policy because an insurance company has dictated they will only cover certain procedures.

"Employees and employers continue to pay hundreds of dollar each month for private medical insurance yet they are restricting what procedures they will cover for their clients.

"We still don't know what procedures are available to patients under their health insurance premium - it is grossly unfair."

Doctors met on Tuesday evening to discuss the legal move and how to proceed.

They said their responsibility to the community will keep them in the operating room as long as possible.

Should the two sides reach an agreement, doctors said they would like to see a Claims Policy and Practice Committee established, to prevent another system breakdown.

It should comprise "a cross section of physicians and representatives of the insurance companies so that we can discuss how best to improve the current process,," the statement said. "We will be approaching the HIAB (Health Insurance Association of Bermuda) so that we can set this up."