March 20, 2012
The House of Assembly has debated Government legislation to regulate the health insurance industry and private healthcare providers. This will, in its current form, impose unrealistic compliance deadlines on all parties as advised by the implementation committee set up by the Ministry. The legislation requires insurers to be able to communicate electronically all patient information including insurance policy coverage in real time to healthcare providers, and to be ready to do this by August 1st. Another part to the bill prohibits healthcare providers from asking patients to pay in full at the time of service. The bill would eliminate, in the Government’s words, upfront payments for service. The Bermuda Dental Association, The Bermuda Medical Association and The Bermuda Medical Society 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.
Why is that important? Because the health insurance providers need to have the electronic systems in place and working in order for the system to work for healthcare providers. The August 1st deadline is very unrealistic. An implementation committee set up by the Health Ministry considered implementation time frames up to five years, but these concerns were dismissed in favour of the August 1st deadline less than four months from now. Many providers are capable of submitting electronically now, but the insurance companies are not able to accept submissions or able to provide the information needed as stated in the legislation.
The Ministry has not given us any confidence that this timetable is doable, though they have expressed hope that it will all work out. We believe this is an instance where care is essential. There is no justification for rushing this act in its current form. Health insurance industry regulation should precede changes to the working relationship between patients and healthcare providers. Although the bill asks the insurers to set up electronic data exchange capability, there is nothing to say they have to so by August 1st. Thus the ability to submit electronically it is often out the providers hands.
Insurance regulation is long overdue. Lack of insurance industry regulation is the main reason why healthcare providers started asking patients for fees at the time of service. The health providers have been asking for this for years. Too often, there was no ready proof to verify who had insurance coverage and for how much or whether the individual had reached a limit. When there is insurance reimbursement, it takes between two weeks to 12 months to receive payment. Can you imagine any other business which would enter a payment agreement where they could not confirm who would pay, how much or when? Yet more than half of all health providers do this voluntarily for their patients. Some providers ask for payment immediately after providing a service, but the vast majority of providers make allowances for patients who can’t pay on the day and set up payment schedules that allow them to either bring in their insurance claim cheques after they get them or take direct payment from their insurance companies. We hope good sense prevails in this matter.
Bermuda Dental Association
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