Negotiations to determine a new treatment fee schedule between local insurers and physicians remain in "limbo", The Royal Gazette was told yesterday.

Until that schedule is finalised, patients must fork out payment for medical services in their doctor's offices on the day of treatment - particularly for obstetrical or surgical procedures.

Patients must then submit a claim to their insurer for reimbursement.

But Permanent Secretary for Health Dr. Derrick Binns told The Royal Gazette yesterday that Government is looking at a period of days rather than weeks to finalise the schedule and end the long-running row.

"It needs to be completed as soon as possible," he said. "It will be sooner rather than later. We're working on it but we have to come up with values that are fair and we can defend."

Doctors and insurers have been battling over a new fee schedule since June 1 when the past agreement expired.

While both sides agreed the old Bermuda Relative Value System (BRVS) for fees was out of date, developing a replacement has been thorny and patients have felt the prick.

While doctors' organisations have said they will not deny any treatment on the basis patients cannot immediately pay out of pocket, some patients have struggled to pay their bills when they need treatment.

Government stepped in months ago and while a fee schedule for anaesthetists and internists was agreed upon, dollar values for other procedures are still subject to bickering.

According to a fax the Health Insurance Association of Bermuda (HIAB) sent The Royal Gazette yesterday, doctors' and insurers' proposals remain hundreds of dollars apart for many procedures.

The biggest gap related to childbirth. For normal deliveries the two sides are $1,100 apart.

According to the fax, doctors are proposing a $2,700 fee for normal deliveries against the $1,600 the HIAB has suggesting as benefit policy. Under the old system, doctors were paid $1,450 for this procedure.

"There are gaps," Dr. Binns said yesterday. "That's what we are trying to resolve. There are a lot of numbers and we are trying to be fair and equitable."

Dr. Binns said Government has to remain aware of the overall costs of health care to the community however.

"It's not so simple that we can just split the numbers down the middle," he said.

Doctors and HIAB are much closer on other procedures which gives reason for hope.

For example, the two sides are separated by just $49 for arthroscopy.

Once a fee schedule is finalised, another open question is what date it will be deemed effective.

Patients who pay a doctor's fee now, may later find that under the new schedule they have been either under- or overcharged.

Dr. Binns admitted this is a possibility.

"It is a very complex question," he said. "We're in a period of limbo on fees. Things are not clear which is all the more reason to get it done."