A frustrated mother of three has questioned the logic of the health insurer Allshores’ policies after finding herself effectively cut out of full coverage for her children’s health examinations.

The Bermuda Health Council said Allshores had acknowledged its benefit wording needed to be “clarified”.

Ricky Brathwaite, chief executive of the council, said: “A benefit should not simply exist on paper; people should reasonably be able to access what is being offered.

“Benefits that do not translate into meaningful opportunities for better health risk becoming little more than words on a screen.”

Amy Molitor spoke out after checking the fine print on her health plan with the company and noticing that it offered to pay 100 per cent of the billed charges for yearly paediatric health exams — only to find the two clinics cited, which are owned by the insurer, lacked full-time paediatricians.

She said: “What concerns me is that families are being offered an enhanced preventive healthcare benefit that appears to be inaccessible through the designated providers.”

The insurer responded that it would consider the feedback “carefully as part of our ongoing review of benefits and member communications, with the aim of making our coverage as clear and helpful as possible”.

Ms Molitor, who took to social media to share the issue, told The Royal Gazette: “I contacted Allshores on October 13 letting them know that I had reached out to both practices listed, and I explained that they didn’t provide the services.

“I asked if we could get covered elsewhere and was denied on the first call, so I requested that they elevate my concern.”

Both medical practices listed, Island Health Services and Family Practice Group, were bought in 2020 by Argus insurance, which itself merged in early 2025 with BF&M to create Allshores.

Family Practice now operates under the umbrella of Family Practice Group, and is listed online under the IHS website.

The insurer’s acquisitions and amalgamation, which came with other client restrictions on high-cost pharmaceuticals for a single pharmacy group, drew the attention of the Bermuda Health Council.

Ms Molitor said she had raised the issue of her children’s coverage with the regulator.

Dr Brathwaite told The Royal Gazette: “From the health council's perspective, this raises an important issue about transparency, fairness and access to care.

“People pay significant amounts for health insurance and should have a clear understanding of what they are entitled to, including any limitations on how or where those benefits can be accessed.”

Dr Brathwaite said the council also recognised that “expected utilisation of defined benefits is a factor in the actuarial modelling used to determine insurance premiums”.

For the policy in question, a $195 paediatric health exam coverage, set at one per policy year, applies to ages 2 to 18.

Ms Molitor said her 16-year-old twins and 12-year-old daughter would have been eligible.

However, she contacted Allshores and the health council after being informed that “neither sees paediatric patients with any regularity, nor does either have a paediatrician on staff”.

Ms Molitor told the Gazette: “We are very happy with our paediatrician. They’ve been seen by him for their entire lives. But copays have gone up in my memory.”

Ms Molitor said the rising prices “led me down the rabbit hole” of reviewing the policy.

After she was denied, she posted on social media: “Considering the cost for health insurance in Bermuda, I find this frustrating.

“Why advertise a benefit that families cannot actually access? And when a policyholder points out the problem, why refuse to make a reasonable accommodation?”

She added: “Surely, if an insurer offers 100 per cent coverage for a paediatric examination, there should be at least one designated provider where children can actually receive that examination.”

The insurer responded that Allshores is “committed to supporting families, which is why our coverage includes a paediatric benefit that applies to local paediatricians”.

“As with standard health insurance benefits, coverage for this paediatric service is subject to a reimbursement cap.

“We appreciate that families may have questions about how this applies to their child’s care and are committed to providing clear information.

“Through our integrated model, eligible members can receive care from family doctors and specialists at Island Health Services and the Family Practice Group, where those services are available, with 100 per cent coverage.

“Importantly, this benefit is not costed into or charged through members’ premiums. Members are not paying for a service they cannot access.

“It is one of several enhanced benefits made possible by Allshores’ integrated model, including waived copays for annual adult physicals and other specialist services at Island Health Services.

“These benefits are not individually reflected in premium calculations; they are part of the value created by our broader healthcare ecosystem.”

She added: “We appreciate our member raising the question about 100 per cent coverage for an annual paediatric visit at IHS. We understand why this is important to families.

“IHS does not have a paediatrician on staff because children have adequate access to care from Bermuda’s excellent local paediatricians.”

Ms Molitor responded that, while the Allshores comment emphasised that the enhanced benefit was not costed into premiums, it did not address whether the benefit on her policy was “actually accessible”.

“A parent reviewing their policy would reasonably understand this to be a benefit available to their children. If the designated practices cannot provide the examination, isn't that potentially misleading to policyholders?”

Last night, Allshores acknowledged the lack of a paediatrician at IHS.

It added: “We appreciate that the way the benefit is described could be clearer as it relates to the availability of paediatric services at IHS.”

Dr Brathwaite said: “Ultimately, we all need a more connected and informed health system where patients, providers and insurers understand their respective rights and responsibilities, information is clear and accessible and everyone can make informed decisions with confidence.

“Right now, there appear to be real gaps between what people expect and what is actually delivered in too many areas of our health system.

“But, as I've been reminding my team recently, we have an amazing opportunity to continue collaborating, developing and delivering solutions rather than simply pointing out problems, all in support of the one community we call home.”

He added: “We'll continue engaging directly with Allshores on the questions raised.”