A top health insurance firm’s change in status for a popular overseas paediatric hospital has been queried by the Opposition after some clinics claimed the move had taken them by surprise.

Robin Tucker, the Shadow Minister of Health, spoke after Argus and BF&M took Boston Children’s Hospital in Massachusetts off its preferred provider network, although the company retains BCH in its overall provider network.

The insurer said the move came after a review of cost-effectiveness, outcomes and long-term sustainability of care.

It was criticised by a leading paediatrician, who cited the highly ranked hospital’s close working relationship with doctors on the island.

The Ministry of Health also expressed concern over the impact the merger will have on the affordability, accessibility, and sustainability of healthcare.

Ms Tucker raised the issue in light of the merger last year by Argus and BF&M, which was acknowledged by the Ministry of Health as potentially concerning for affordability and accessibility of healthcare.

Argus and BF&M said it routinely evaluated its providers and that its roster of preferred providers retained “globally renowned paediatric institutions”.

It said the move would not affect clients or children already undergoing treatment at BCH.

Ms Tucker called the change in status for BCH “concerning” in light of the decades that BCH had treated child patients from Bermuda.

She added: “Boston Children’s is ranked as the No 1 children’s hospital in the US and is consistently ranked among the best globally.

“The result of this decision is that some families will have to go elsewhere because of an inability to pay the portion of medical costs that will be uncovered by insurance.”

Ms Tucker said the move raised “further concern about the impact of mergers of key service providers such as insurance companies and the impact it has on the people of this tiny island”.

The Bermuda Health Council said that it advocated as the regulator for transparency on decisions by insurance companies.

Ms Tucker said: “As the working population continues to shrink, health premiums continue to rise at unsustainable rates and we see coverage options shifting.”

She added: “The merger of two of three major health insurance providers has basically stripped Bermudians of choice and we find ourselves at the mercy of the insurance companies.

“During the Budget, the Government promised refinement of regulatory oversight for health insurers.

“I would hope that as part of that refinement, they will strengthen the Bermuda Health Council’s powers sufficiently to ensure that there is greater protection for Bermudians in the health insurance space.”

Kim Wilson, the Minister of Health, said last year that the Government would “closely monitor” the amalgamation to “safeguard the interests of the public”.

Last night a Ministry of Health spokeswoman said: “The ministry is aware of recent changes to provider networks following the merger and recognises the concerns expressed by members of the public regarding potential implications for continuity of care, patient choice and out-of-pocket costs.

“While the ministry does not have the authority to direct the business decisions of private insurers, including network configurations or pricing structures, it maintains a vested interest in ensuring that such changes do not undermine the health and wellbeing of Bermuda’s residents.

“Accordingly, the ministry expects that:

“Any adjustments to provider networks are managed with a high degree of transparency and that affected stakeholders — including patients and providers — are given adequate notice and support to mitigate disruption.

“The continuity and quality of healthcare services are preserved throughout the transition period, with particular attention paid those requiring ongoing or specialist care.

“Private insurers remain mindful of the financial burden placed on policyholders, particularly in the current economic climate.”

• To read the full Ministry of Health statement, see Related Media

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