PHILIPSBURG–Family practitioners in St. Maarten will not be accepting private insurance cards as of today, Thursday, because they are unable to come to an agreement with the St. Maarten Insurance Association (SMIA) on a cost-of-living adjustment (COLA) payment.
This puts possibly thousands of cardholders in jeopardy. Cards that will not be accepted are NAGICO, Ennia, Fatum, Sagicor and Alico. Cardholders will be required to pay cash up front and will be given receipts to claim repayment from their insurance companies.
Health Minister Cornelius de Weever said he was aware of the situation and had met with both parties separately to resolve this issue amicably. “My next attempt will be to ask both parties to come to the table and resolve this challenge,” De Weever said in an invited comment on Wednesday.
In two notices that appear elsewhere in today’s paper the family practitioners said they had been negotiating with the private insurance companies since 2009 for a “long overdue” COLA.The medical practitioners, who are members of the Windward Islands Medical Association/St. Maarten Medical Association (WIMA/SMA), said they no longer would accept the private insurance cards because they had not received any COLA from 2000 to 2012, which they contend accumulates to a 130 per cent loss for general practitioners and a 130 per cent savings for insurers.
The associations said too that general practitioners no longer could absorb these losses while all other cost kept rising at the same time. The long-term effect of these below-market-value rates is quantity and not quality care.
“Therefore, with regret, but forced by the persistent negative response from the insurance companies, the family doctors will, as per Thursday, September 27, no longer accept these cards as the form of payment,” one of the notices read.Doctors who will not be accepting the private insurance cards are Dr. A. Arrindell, Dr. P. Arrindell, Dr. Bouman, Dr. Bus, Dr. Datema, Dr. Deketh, Dr. Dennoui, Dr. Douglas, Dr. Foeken, Dr. Herles, Dr. Knol, Dr. Mercuur, Dr. van Osch, Dr. Perez, Dr. A. Raghosing, Dr. R. Sanchit, Dr. Simmons, Dr. Spencer, Dr. Swanston and Dr. Tjaden.
In one of the notices WIMA/SMA said it did not agree to continue accepting the rates dating back to 2000 currently paid by insurers.
In its statement WIMA said, “These insurers, of which the majority, if not all, are represented in the St. Maarten Insurance Association (SMIA), and the general practitioners, represented by the WIMA/SMA, could not reach an agreement after their last meeting of September 18, 2012, on WIMA’s February 2009 proposal to adjust the medical rates of 2000 for the increased cost of living.”
The medical practitioners said WIMA had proposed to the insurers to adjust the 2000 rates from February 2009. “These 2000 rates were adjusted yearly from 1998 to 2000 based on a three-year agreement of 1998 between the Island Government and WIMA. These yearly upward adjustments were based, as agreed, on the yearly cost-of-living adjustment price increase as determined by Government’s Bureau of Statistics.“These bare-bone rates are, by itself, insufficient as they do not provide for pension nor sick leave insurance for the doctors. Despite WIMA’s attempts to meet with Government to renew this agreement, meetings never took place and at expiration of this agreement at the end of 2000, there was no follow-up agreement. So in February 2009, after eight years of no cost-of-living adjustments, the WIMA proposed to the insurers to again apply this. Only two out of 56 medical rates were adjusted in 2003, in negotiation with Government.
“In 2009, the WIMA proposed cost-of-living adjustment for the 2000 rate is the same cost-of-living adjustment calculated and published by the Bureau of Statistics and applied to unionised and government workers. According to this same bureau the total cost of all healthcare went up less than the total cost of all insurances,” it was stated in the notice.
WIMA said it had received a letter from the Health Department dated May 15, 2012, stating that “current legislation permits the government to adjust tariffs for only SVB/BZV/PP/FZOG-insured population.
“This letter was immediately forwarded to the SMIA and a meeting was requested. It took the SMIA a reminder and six weeks to have a first meeting with WIMA/SMA. Furthermore, mediation, on request of the SMIA, on Sep. 24, 2012, by the Honourable Minister of Public Health Social Welfare and Labour Mr. V.H. Cornelius de Weever did not lead to any counterproposal yet from the SMIA,” it was stated in the notice.“SMIA’s response is simply ‘no’ to any of our requests for adjustment. The SMIA refuses by letters of July 2012, August 28 and September 24, 2012, to apply any adjustment. At the same time the SMIA demands ‘proper procedures,’ but fails to answer what these are, on which laws these are based and why they feel these have not been followed since WIMA’s 2009 proposal.
“The SMIA suggests to meet with the WIMA/SMA to come to a mutually agreed course of action without, again, answering what is their proposed course of action and timetable. WIMA/SMA at the September 18, 2012, meeting proposed to SMIA for the SMIA pay the increase caused by the long-overdue adjustment in January 2013; this to give the insurers the chance to adjust their premiums accordingly in January 2013, and remain within their expected budget for 2012.”
