No outsourcing of health insurance claims to India, states Government
FutureCare and HIP insurance claims are not outsourced to India, the Ministry of Health has stated.
Shadow Health Minister Louise Jackson told the House of Assembly that claims were being sent to the Asian nation for processing.
During the Health Budget debate last week, the Opposition MP said it was a sad day if Government couldn't find Bermudians to adjust claims.
She said: “It's a nightmare to call for a claim and go through India. It's a nightmare and it needs to be remedied.”
A Ministry of Health spokeswoman said this week that claims were not processed in India, however a company based in the country has been contracted to do back-office support and maintenance for an IT application.
“Contrary to Mrs Jackson's comments in the House of Assembly, the public has no contact with Apollo staff whatsoever.
“The public only interacts with HID [Health Insurance Department] staff in Bermuda, except for overseas claims where they deal directly with the Canadian Medical Network (CMN).
“CMN manages overseas claims for Argus, [Lady Cubitt Compassionate Association] LCCA and [the Government Employment Health Insurance scheme] GEHI in addition to HID's overseas claims. All this information has been made available since 2008.”
The spokeswoman said the India-based company Apollo Health Street had been contracted to complete data entry and claims auditing to verify that claims were processed correctly.
She said the department has fielded questions in the past about “outsourcing”. And she pointed out that the department issued requests for proposals (RFPs) for the project back in June and September 2007.
Cabinet agreed with a recommendation to pursue automation using a combination of off-the-shelf software and services intended to support the software by means of an outside vendor in January 2008,” she said.
Both local and overseas vendors were short-listed and interviewed and the group chosen in June 2008 was Apollo Health Street.
The implementation of the system began in early 2009 and was completed in September 2010.
The RFP was posted on Government's ITO website and a PowerPoint presentation is publically available at www.hfs2010.gov.bm under the presentations section, she added.
According to the spokeswoman, the department had partnered with a number of organisations for reasons of efficiency, expertise and quality.
“The Department seeks strategic partnerships to modernise and raise its standards in the most effective manner. Its partners help it to quickly achieve best practices without having to build the infrastructure itself,” she added.
The Ministry could not answer how much the same service would cost if operated on the Island and said: “The functionality being performed in India was never performed in Bermuda previously.
“Apollo was the winner of the RFP because of its expertise in health care management globally and because it was the highest rated vendor based on the scoring matrix, demonstration and responses to questions.
“The selection process was vigorous and lasted 12 months.”
In the debate Mrs Jackson also asked Health Minister Zane DeSilva to state what the fee for FutureCare would be when the next phase begins on April 1.
The Ministry said it would make this announcement after it had consulted with the Cabinet. “The public can expect this information in due course,” the spokeswoman added.
Useful website: www.gov.bm