House to debate upfront medical payments
MPs will today debate a proposed new law banning upfront payment for healthcare services, amid opposition from doctors and dentists.
The regulations will stop healthcare providers making patients pay the insured portion of their bill before reclaiming at a later date from their insurance company, which the Ministry of Health claims forces some patients to forgo care.
The Ministry says healthcare providers have refused to voluntarily cease the practice, so it will legislate against it through the Health Insurance (Health Service Providers and Insurers Claims) Regulations.
Providers will also have to switch to electronic claims submissions by August 1, to help ensure insurers make prompt payments, if the regulations, which are backed by Bermuda Health Council, are passed.
However, Bermuda Dental Association, Bermuda Medical Association and Bermuda Medical Society have all voiced opposition to the proposals.
In a letter in today’s
Royal Gazette [see Page 4], those groups say the vast majority of health providers already make allowances for patients who are unable to pay on the day.
They add it’s unrealistic to expect health insurance providers to get electronic systems in place by August 1 so that the new process can work properly.
The Ministry of Health said in a statement last night: “The Ministry of Health has been working with BHeC, healthcare providers and insurers on the matter of upfront charges since 2008.
“Despite years of work, the situation has not improved and complaints continue to be received that some patients forgo care because they can’t afford to pay, upfront, sums ranging from $200 to thousands of dollars.
“The Ministry is concerned that patients’ access to care is being unduly compromised and there being no current valid reason for the practice of charging upfront, and insufficient willingness from providers to cease it voluntarily, has had to legislate against it.”
Chris Allington, writing on behalf of the dentists and medics associations, agreed with the need for health insurance regulations, but said changes to the working relationship between patients and healthcare providers should not be enforced at this stage.
“Healthcare providers do not support this bill because they believe the portion of the bill affecting their relationship with patients should be separated from regulatory changes intended for the health insurance industry,” he wrote.
Responding to that point, Health Council CEO Jennifer Attride-Stirling said: “It isn’t clear from the letter why healthcare providers believe that the insured portion of a bill should be separated from insurance regulations.
“The letter says that they ‘should’ be treated separately but doesn’t provide any reason why.”
Dr Allington’s letter said the August 1 deadline allows just four months to get a new electronic system in place; yet the Ministry had initially considered a time frame of up to five years.
He wrote: “We believe this is an instance where care is essential. There is no justification for rushing this act in its current form.”
The Ministry replied: “The Ministry of Health is aware that the implementation committee recommended three to five year timelines.
“While there was a great deal of merit in many of the recommendations and many points from the committee were incorporated into the legislation, the proposed timeline was deemed unacceptable, as it fails to address the current problems in restricting patients’ access to care.
“Upfront charges affect most severely people who are ill and with limited financial means.
“The current economic climate has made this situation even more severe for people who are hurting financially, so it was imperative for the Government to act promptly to address this problem in the community, which was not being resolved voluntarily.
“The Ministry is confident that if healthcare providers are paid in less than 30 days, as they are currently, there is no need to charge patients upfront.
“In fact, a majority of providers don’t charge upfront, so the legislation presents no change for them other than to guarantee prompt reimbursement by insurers.
“Dr Allington’s allegation that the legislation is being rushed is unfounded. The issue has been in discussion since 2008.
“A survey was done in 2009, and best-practice guidelines were issued in 2010 to encourage providers to abandon upfront charges voluntarily.
“We are now in 2012 with no improvement in the situation. Providers have had years to change their practices voluntarily, but didn’t take it up in time.
“Many in the physician community were, in fact, beginning to move in a positive direction to cease the practice. But it was clear that some healthcare providers would not stop charging upfront without legislation.”
Dr Attride-Stirling added: “The letter states that healthcare providers don’t support the bill. It is true that some don’t support it, but there are others who do understand the need for legislation.”
Dr Allington’s letter stated nobody in the healthcare industry asks for upfront payment before service is provided; Dr Attride-Stirling responded that upfront payment actually refers to the practice of patients having to pay the insured portion of the bill at the time of service.
Dr Attride-Stirling added that the new regulations also enforce insurers to give healthcare providers the information they need so they don’t have to charge upfront, and make insurers pay healthcare providers promptly.
“It isn’t clear why providers object to this. Insurers agree to these terms,” she said.
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