Doctors have hit back angrily at the insurance industry, accusing it of issuing an "unseemly and misleading" advert as the row over new hospital fees continues.

The Bermuda Medical Society (BMS) and Bermuda Medical Association (BMA) say they are not trying to boost their income by calling for an American-based charging scheme to replace the current fee structure.

Doctors and the Health Insurance Association of Bermuda (HIAB) are locked in a dispute over a new payment structure to replace the Bermuda Relative Value Schedule (BRVS).

Doctors reject the new system, which they say insurers are trying to impose on them, and have warned that patients will be left to pick up the tab if their insurance policies do not cover the new costs of the treatment.

A new structure, called the CPT coded payments system, has been proposed, but doctors say the health insurers do not want to implement it uniformly and they will pay doctors differently for roughly the same work.

In a letter to The Royal Gazette, the doctors accused the HIAB of trying to impose the new system on a selective basis, which would prolong the old system of unequal payments to doctors.

BMS and BMA were angered by a full page advert in The Royal Gazette on June 21, in which BHIAC said doctors wanted to move to a Miami-based schedule which would see fees for a hysterectomy rise from $924 under the current system to $1,185 under the proposed replacement and to $4,328 if the doctors get their way.

HIAB said it had no evidence to support claims by the medical profession that their income would fall by between 30 and 50 percent if the CPT coded system was introduced.

But the doctors have responded saying: "The medical community normally maintains a dignified silence but feels obliged to respond to the unseemly and misleading advert taken out by the HIAB.

"We are sorry that this debacle has entered the public domain. We feel it is time that you, our patients, were informed of the state of your health care."

The HIAB was seeking to impose the new CPT coding on doctors on a selective basis, according to the BMS and BMA letter.

"They also want to pay doctors differentially, some earning more than others for doing an equivalent amount of work. We think this merely continues the inequalities of the old system," the letter states.

"It has never been the intention of doctors to increase remuneration at this time, merely to avoid a loss of salary.

"Indeed, with this new system imposed by the HIAB, the doctors remuneration, it is stated by the HIAB, will increase - while from our calculations, some will suffer a drop in their hospital incomes."

Health insurance premiums have undergone a "massive" increase this year, states the letter and the increases proposed in the new payment scheme will further fuel the costs of healthcare.

Colonial Medical, which is not a member of HIAB, is co-operating with doctors and processing bills without problems.

But other HIAB companies are holding up or will not process new claims, the letter states.

"This may force some doctors to directly bill or balance bill their patients. We profoundly regret having to take this action but otherwise we will not be able to pay our staff or office expenses.

"We write this letter to be informative, not inflammatory, and hope the HIAB will not continue this debate in public, but, instead, work towards agreement."