The original article can be found in: The Royal Gazette By Jonathan Bell
Anxieties linger in the healthcare industry, over tomorrow’s deadline for the end of upfront charges on the insured portion of a doctor or dentist’s service.
Bermuda Dental Association head Chris Allington told The Royal Gazette: “I think there is a lot of trepidation still. People are concerned because of the uncertainty.”
His own dental practice dropped the upfront payment practice back in April, Dr Allington said, and a number of practices have been content with receiving payment from insurers all along.
But as of August 1, according to the legislation technically known as the Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012, the practice will no longer be allowed.
“We are going to have some confusion,” he charged.For Dr Allington, the uncertainty lies principally with the new regulations’ stipulation that insurers pay up on electronically-submitted claims within 30 days of receipt.
Providers are not required to file their claims electronically.
“From the providers’ perspective, all along, we have been asking for insurers to give us their real-time results of what they cover,” he said. “Insurance coverage has not always been made available to us.
“Some insurers are doing a good job trying to comply by August 1, and others still won’t have that information available. They’ve made an effort, but it’s still not available online.”He said: “We have had meetings with all four of the big insurers to find out what state they’re at. A couple are a little bit behind. We still don’t have all the information as easily accessible as we would like.”
He added: “It’s encouraging to see that this legislation has insurers moving in the right direction, in providing the real-time information that we need. Colonial and BF&M have made significant upgrades in their websites. But I believe insurers in general don’t feel they have been given enough time.”
Medical specialists are liable to be the worst-hit in the switch, he predicted.
“Specialists are going to have a lot more difficulties than the dental practices, because of the complexities of their coding system.”But healthcare providers in general face a one-sided deal, he said, since claims can still be made on paper — but insurers are not beholden to a 30-day payment in that event.
“We can’t submit it electronically if they don’t provide the information,” Dr Allington said. “The reality is, with this legislation, insurers get off. If they don’t turn around their paper claims in 30 days, we don’t have any recourse.”
Dr Allington said he did not anticipate a sudden wave of customers once the upfront payments are struck down — a position echoed by Argus CEO Allison Hill.
“We do not anticipate a sharp rise in claims with the August 1 ban on upfront payments,” Ms Hill said. “We are committed to working with providers and patients alike to ensure a smooth transition of this law.”
Physician Femi Bada, a critic of the regulations when they were rolled out in March, continued to call the legislation a rushed job.“It’s a very short period of time to get all these stakeholders to go from manual to electronic,” he said. “Many insurance companies have not got all their acts together.”
However, Dr Bada said he expected the switch to encourage struggling patients to attend doctors and dentists.
“I think most people who are working may be able to afford it, whereas an older person going to a specialist for treatment of cataracts would have a serious difficulty,” he said. “They may be told to come back two weeks later for a follow up, and not go. There’s where this legislation comes from. And we have never said that we were for upfront payments.”
Dr Bada said that even at the eve of the deadline, “there is nothing concrete as regards electronic payments”.
“For example, I have been asking Government Health Insurance to give me the system they are using, and I still don’t know.”
Following the implementation of the regulations, he said, “the first few weeks are going to be interesting”.
Along with rules for providers and insurers, the Bermuda Health Council (BHeC) has the job of granting exemptions to providers.
Providers may also request the ability to charge for the insured portion at the time of service. Payment times can be varied with BHeC approval, and the organisation also has the power to penalise companies which fail to obey the rules.
Asked if there had been many requests for exemption, BHeC CEO Jennifer Attride Stirling said the number to date had been “manageable”.
“BHeC has been working with providers and insurers in preparation for August 1, and we have seen a huge amount of good will on both sides to make the legislation work.“Insurers have given much more information about their coverage and eligibility, and providers have more clarity about the claims process.
“Overall, the claims filing procedure hasn’t changed — the same information will be needed from August 1 as has been needed for years in order to process a claim swiftly.
“August will be a transition period and we will monitor how things are going and continue to work with providers and insurers to facilitate the process.”
She said the regulations had made for “a very busy period for insurers, providers and the Health Council”, adding that “the policy direction and its spirit is understood by most stakeholders”.
Asked for a top misconception on the regulations, she said: “It’s important that patients be understand the difference between co-pays and the full charge.
“In addition, appliances are excluded from the regulations — so providers can still charge upfront for things like glasses and crowns.
“These have to be custom-ordered for each patient, so providers are not expected to absorb the cost.”
Further information is available online, at the Council’s website, www.bhec.bm.
