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Government apologises for FutureCare error

Health Minister Zane DeSilva

Government has apologised to FutureCare clients for failing to inform them of a change in co-payments.It also reassured that they will not be hit with bills backdated prior to April 1 2011, despite a system error that led medical providers to be paid more than they should have been until that point.The statement came two days after The Royal Gazette first revealed news of the problem, and a day after questions were raised by the Opposition in the Senate.We reported that, since its inception in 2009, Government’s FutureCare scheme had been reimbursing surgeons 100 percent for procedures performed at the local hospital.As of April 1, 2011, the scheme began to reimburse only 75 percent without explanation or prior notice to doctors or clients.Health Minister Zane DeSilva said in response to a query: “FutureCare has not changed its benefits policy.“The Health Insurance Department (HID) discovered a system implementation error, which resulted in medical providers being paid more than they should have been.“HID made the system configuration changes and implemented this as of April 1, 2011. The configuration issue was discovered internally and acted upon immediately when found.”The Minister went on to say that policyholders are not typically informed when the automated system is “tweaked”.However, Senator Michael Dunkley asked the following day why FutureCare clients had not been informed of the issue and what is being done to address it.Last night, the Health Insurance Department issued a press statement saying: “The implementation of co-payments under FutureCare for outside specialists and general practitioners performing services at the hospital, like the implementation of co-payments on pharmacy benefits in April 2010, were items that were originally intended to be done at the outset, but were delayed for technical and logistical reasons.“Typically, the Health Insurance Department has written directly to FutureCare policyholders and medical providers to fully explain such changes.“For April 1, 2011 and for this particular system configuration, this was not done. This represented a break from the department’s normal communications approach and clearly it has a financial impact on policyholders and medical providers.“There was a failure to inform the relevant stakeholders and for this, the Director of the Health Insurance Department sincerely apologies for any anxiety or uncertainty which may have resulted.“This was unacceptable and could have been avoided if correspondence had been sent as it had been in the past.”The statement added: “To correct this, technical officers at the department are taking urgent steps to communicate this change to all policyholders and medical providers and will send out a notice to describe this change, in detail.”It also stated: “Questions have been asked about whether or not FutureCare policyholders will be asked to reimburse the department for claims paid by the department between April, 2009 and March, 2011.“We wish to be clear that the 25 percent co-pay which was implemented on April 1, 2011 will remain in place. Policy holders will have to pay any co-pays which apply to treatment provided since that date.“The Health Insurance Department will not ask FutureCare policy holders to reimburse the department for any claims paid for treatment received prior to April 1, 2011.“Those claims were paid correctly in accordance with the department’s rules at the time.”The statement said the department would update its website with more information and explanations of its policies and procedures and added that “FutureCare will continue to offer seniors an affordable comprehensive health insurance option”.