More doctors are considering making patients with only Government health coverage pay up-front for medical treatment due to chronic sluggish repayment of claims.

Acting Health Minister Philip Perinchief said three months ago he was aware of patients being forced to pay medical bills in full because of delays at the Government’s Health Insurance Plan (HIP).

Four physicians’ practices had already pulled out of the HIP scheme — asking patients to pay the bill, in full, straight away — and now The Royal Gazette has learned that three more are thinking of following.

Even staff at the Premier’s clinic, Bermuda Healthcare Services, admit they have to “harass” Government to get HIP payments.

The problems with HIP have come to the surface as Government announced that former Medical Clinic patients will also be put on the system.

The Medical Clinic — which Health Permanent Secretary Warren Jones said treated 500 patients for a cost of $2,521,522 last year — is to close under plans announced by Premier Ewart Brown. HIP is the standard health plan offered by the Government under the Hospital Insurance Act 1970, which is overseen by the Hospitals Insurance Commission and the Minister of Health.

Doctors are frustrated by a backlog in HIP claims and say, while they do not want to put undue financial pressure on patients, they may have little choice.

“We have considered asking patients to pay up front, but that puts the problem on the patients,” said one doctor, who asked not to be named.

“Most reimbursements take up to three months, but some take over six months and some are longer. It’s because they’re backed up. So, it’s hard to run a business.”

Another physician said it was not just delays in payment causing problems but also the failure to itemise bills. When seeing regular patients, it becomes difficult for physicians’ offices to track which treatments have been reimbursed and which have not.

“We still take HIP, even though it takes a long time for them to pay,” he said. “To ask the patients to pay up-front would penalise the patients.

“But there is a long-standing problem about receiving payments. The other problem is that, unlike other insurance companies that itemise the bill, HIP just sends you a cheque.

“I have specialists that deal with senior patients and they will see them multiple times, and operate on them, and then have to wait 18 months to be paid. When we do get the cheque, we don’t know for when or what it was for.”

Mr. Jones admitted this week that the Ministry is aware of the problems with HIP, many of which he said are ongoing issues between the Ministries of Health and Finance. These problems are being dealt with, he said, and the current backlog of claims will be addressed — but the claims outstanding for the Bermuda Hospitals Board must be addressed first.

“In this regard the Department of Social Insurance has recruited additional temporary staff which began employment effective April 1,” Mr. Jones said.

“Those vacancies now having been filled by the beginning of May, training has been ongoing to bring staff up to speed. In the first instance, staff have been focused on dealing with the largest volume of claims, those of the Bermuda Hospitals Board.

“We anticipate completion of that process within two months. Once the back of that has been broken, staff will then be assigned to carry out similar focused attention to the outstanding physician and lab claims.”

Overhauling the the system of claims processing and putting it on the computer will also improve the situation, Mr. Jones said.

With these adjustments, he predicted physicians could be paid within 30 days by the end of the year.

“The plan as outlined above will make this a reality within this calendar year,” he said.

Mr. Jones also disputed previous reports that there will be 1,500 Medical Clinic patients added to the HIP scheme. He said the number is actually closer to 500.

The majority of the former Medical Clinic patients coming onto HIP will be elderly — as are the majority of those covered by HIP at the moment.