Dr Allington & Ministry On Upfront Payments
Dr. Chris Allington said if the Government’s health insurance legislation passes in its current form it will “impose unrealistic compliance deadlines on all parties,” while the Ministry of Health defended the proposals about upfront medical payments saying the Ministry is “concerned that patients’ access to care is being unduly compromised”
Dr Allington said, “The House of Assembly today will debate Government legislation to regulate the health insurance industry and private health care providers that will, if passed in its current form, impose unrealistic compliance deadlines on all parties.
“The legislation would require insurers to be able to communicate electronically all patient information including insurance policy coverage in real time to health care providers, and to be ready to do this by August 1st.
“Another part to the Bill prohibits health care providers from asking patients to pay in full at the time of service. In the Government’s words, the Bill would eliminate upfront payments for service.
“The Bermuda Dental Association, The Bermuda Medical Association and The Bermuda Medical Society do not support this Bill because they believe the portion of the Bill affecting their relationship with patients should be separated from regulatory changes intended for the health insurance industry.
“Why is that important? Because the health insurance providers need to have the electronic systems in place and working in order for the system to work for health care providers.
“The August 1st deadline is very unrealistic. An implementation committee set up by the Health Ministry considered implementation time frames up to five years, but these concerns were dismissed in favour of the August 1st deadline – less than four months from now.
“The Ministry has not given us any confidence that this timetable is doable, though they have expressed hope that it will all work out,” continued Dr Allington.
“We believe this is an instance where care is essential. There is no justification for rushing this act in its current form. Health insurance industry regulation should precede changes to the working relationship between patients and health care providers.
“Insurance regulation is long overdue. Lack of insurance industry regulation is part of the reason why health care providers had to start asking patients for fees at the time of service. There was no ready proof to verify who had insurance coverage and for how much or whether the individual had reached a limit.
“When there is insurance reimbursement, it takes between 2 weeks to 12 months to receive payment. Can you imagine any other business which would enter a payment agreement where they could not confirm who would pay, how much or when? Yet more than half of all health providers do this voluntarily for their patients.
“The last point we’d like to make involves so-called upfront payments from patients. No one in the health care industry asks for upfront payment, which is a payment prior to service.
“Some providers ask for payment immediately after providing a service, but the vast majority of providers make allowances for patients who can’t pay on the day and set up payment schedules that allow them to either bring in their insurance claim cheques after they get them or take direct payment from their insurance companies.
“We hope good sense prevails in this matter,” concluded Dr. Allington.
The Ministry of Health responded saying, “The Ministry of Health has been working with BHeC, healthcare providers and insurers on the matter of upfront charges since 2008.
“Despite years of work, the situation has not improved and complaints continue to be received that some patients forgo care because they can’t afford to pay, upfront, sums ranging from $200 to thousands of dollars.
“The Ministry is concerned that patients’ access to care is being unduly compromised and there being no current valid reason for the practice of charging upfront, and insufficient willingness from providers to cease it voluntarily, has had to legislate against it.
“The Ministry of Health is aware that the implementation committee recommended three to five year timelines. While there was a great deal of merit in many of the recommendations and many points from the committee were incorporated into the legislation, the proposed timeline was deemed unacceptable, as it fails to address the current problems in restricting patients’ access to care. Upfront charges affect most severely people who are ill and with limited financial means.
“The current economic climate has made this situation even more severe for people who are hurting financially, so it was imperative for the Government to act promptly to address this problem in the community, which was not being resolved voluntarily.
“The Ministry is confident that if healthcare providers are paid in less than 30 days, as they are currently, there is no need to charge patients upfront. In fact, a majority of providers don’t charge upfront, so the legislation presents no change for them other than to guarantee prompt reimbursement by insurers.
“Dr Allington’s allegation that the legislation is being rushed is unfounded. The issue has been in discussion since 2008. A survey was done in 2009, and best-practice guidelines were issued in 2010 to encourage providers to abandon upfront charges voluntarily.
“We are now in 2012 with no improvement in the situation. Providers have had years to change their practices voluntarily, but didn’t take it up in time. Many in the physician community were, in fact, beginning to move in a positive direction to cease the practice. But it was clear that some healthcare providers would not stop charging upfront without legislation.
“Dr Allington’s letter states that providers don’t support the Bill. The Ministry is aware that some providers, like Dr Allington, oppose it, but there are other providers who do support it, who agree with the requirements the Bill makes of insurers, and who have advocated for upfront charges to cease because of the way it compromises patients’ access to care.”
This is the first time I have agreed with Minister of Health. Vendors who demand upfront money from Patients at their most vulnerable are unscrupulous at best. Please pass this bill. Then I want the Insurance companies to review the prices that these Vendors are sticking to us Patients. Surely routine lab tests should not be as astronomical as I see on my Insurance co-payment statements. If these costs could be better regulated, then maybe people could then afford upfront payments. But, not until…
Let’s see how the OBA can be on both sides of this issue
How is this relevant to the topic?
The idea of not requiring up-front payments is a good one but a major problem is that Government insurance such as GEHI, FutureCare and HIP can be up to a year behind in payments to doctors and dentists. Now who in their right mind will provide health care services (or any other services) knowing that the chances of being paid within even a few months are slim to non-existent? What will Government do to guarantee it will obey it’s own regulations and make payments within 30 days, or will it be exempt!
And what if the person receiving treatment has lost his or her insurance coverage because they have lost their job or not paid their monthly contributions? How does the doctor or dentist know this? Who do they call?
Bingo, as a matter of fact GEHI, HIP, and Future Care ARE the worst offenders when it comes to getting a timely reimbursement. So again it looks like the government needs to get its act together and make some people work a little harder to get these claims processed faster than 120 days.
Duh…that’s why government has put in their electronic accounting system. It’s been kinks and headaches the first few months but by Aug 1 it should be more streamlined. I pay insurance so that it covers me when Im most in need. Take your argument to the insurers that pay late Dr. A not the everyday person. Pass this bill!
PS any insurance place that is not operating accounts electronically in the 21st century should be fired. Seems like the old boys clubs of medicine and dentistry are not up to date!
My post was not an argument. And I agree that the policy holder should not be inconvenienced just because some insurance companies are incapable of giving timely reimbursements to providers. It is in fact very sad that some providers would have to resort to that. In the US most claims are reimbursed to the provider within two weeks. Can you imagine how many more claims they are processing compared to Bermuda? The government can not mandate a private insurance company to do anything so it will be the provider who suffers. BTW I am all in favor of this legislation so no need to jump the gun again.
Itiswhatitis – Ask yourself the question – would I like to do work and then wait to be paidd for it for as long as the insurance company deems realistic? That is why the medical professionals moved to up front payment in the first place because the insurance companies paid only 90% of the invoices submitted, leaving those medical professionals with huge receivables that were never paid. When the patient collects on their own, they will not let the insurance company not pay, they will chase until they are reimbursed. Just because Doctors as a general rule make more than the average does not mean that they do not deserve to be paid on the day that they performed that service…… wake up and stop being so selfish
Well the insurance companies should have started to make adjustments to prevent such a backlog/delay in payments.
Some people who want to go to the doctor or dentist but dont because they cant afford the upfront payment (which is sad because they have insurance).
Insurance companies should have found ways to be more efficent in their payment system.
Selfish??? I could say the same for the Vendors. With all their intelligence and skills, one would think they would be able to muster up a few brain cells, have a meeting with the Insurance companies and devise a method in which to get paid more quickly. No, they take the path of least resistance and go after the Patient. I suggest you wake up and STFU.
Selfish?!?!?! Who’s being selfish?!?!?! Boo! Hoo! The over charging doctors are not getting paid on time so they might not make their monthly golf club membership. Let me break out the mini violin.
Who’s more selfish than doctors or dentists who can’t give the average working person a flexible appointment time because they never work a full day? Who’s more selfish than doctors or dentists when you get to your appointment on time but only get seen & hour later but don’t you dare come late to your appointment or it will be cancelled & you will still get charged for it? Who’s more selfish than doctors or dentists who after you’ve done your yearly check up set you another inflexible appointment to just come it to get your results but are charged for it. Doctors provide a necessity that they full well know they can charge whatever for & do because its that or get sick & die. If doctors were not selfish there wouldn’t be so many in house pharmacies popping up in every doctors building. If doctors were not selfish they wouldn’t be trying to get degrees in plastic surgery & shafting other patients out of flexible appointments so they can get money from their other patients who just want to look pretty. If there was greed pie chart made to represent each profession in Bermuda it would be a toss up between doctors, dentist & lawyers to will take the whole cake. If doctors in Bermuda weren’t so selfish many Bermudians would be sent off to Lahey or Johns Hopkins before its too late for there limbs or life to be saved.
Bermudian doctors should be happy they can practice in a jurisdiction where their allowed to rip people off so much. They are lucky they are not practicing in Canada where the government decides what they are to charge & the government decides how & when they get paid while people get good service for free. We are a majority unhealthy bunch in Bermuda & doctors here love it that way.
“insurance companies paid only 90% of the invoices submitted, leaving those medical professionals with huge receivables that were never paid”
This is the reason the Government wants the insurance companies to supply “real time” access to coverage information. Pharmacies have been doing this for years, so why cant others?
Who is Dr. Chris Allington? Is he a dentist or doctor?
does it matter?…
Why does it matter which one he is? Need to get your facts straight before you attack his integrity too?
Yes, it matters. That’s why I asked the question. Normally, a journalist would provide that information. Don’t forget, the people have a right to know. But as far as you’re concerned, we only have a right to know some things.
He is probably another one of those dang Furniners so off with this head and send him back where he belongs…..Let us Build One Another Together Laverne……on another note if members of the medical profession were being asked to do something that would get them their money faster they would suggest the August 1st deadline be pushed up to next week…..
He’s not a “real” “Bermudian”.
WHAT ABOUT BERMUDA’S SENIORS? HOW ARE WE EVER GONNA BE ABLE TO PAY UP FRONT? WE ARE SUFFERING NOW!I AM JUST ABOUT EATING NOW AND NOW U EXEPECT ME TO PAY MY MEDICAL PAYMENTS UP FRONT!!DO YOU CARE ABOUT SENIORS? THIS IS A HUGE BURDEN? I AM ALREADY TRYING TO DECIDE WHETHER TO BUY MY PRESCRIPTIONS OR BUY FOOD! PLEASE DONT MAKE SENIORS PAY UP FRONT FOR MEDICAL PAYMENTS BECAUSE IT WILL BE DETRIMENTAL FOR MANY OF US AND I HAVE MANY SENIORS AS FRIENDS THAT WOULD NEVER SURVIVE!HAVE SOME SORT OF COMPASSION! GOD WILLING ONE DAY YOU WILL GROW OLD TOO! FOR MANY YOU ARE NOT TOO FAR AWAY NOW!
I think you have it wrong, the Health minister is trying to stop the Doctors from charging you for up front payments.
What about this seniors subsidy – is it for just the hospital or all seniors who aren’t able to meet their medical bills? I would love to know this one
The Age Subsidy gets turned on for those 65+ (once you go to the Health Insurance Dept. and apply for a Certificate of Entitlement – which states you are ordinarily resident and have been some for a number of years) Once you get your COE then seniors are covered at a 80-20 co-pay at the hospital from 65-79 years old and 90-10 co-pay for 79+ years.
The Indigent Subsidy is for those that cannot pay at all, and the Geriatric Subsidy is for those that cannot take care of themselves at all (most times they are seniors and are permenantly at BHB in the care unit there) Hope this helps.
Sorry,… 65 – 74 is 80-20 co-pay and 75+ is 90-10.
Personally, I’m against up front payments, but any changes to the system need to be properly thought out to provide safeguards against abuses. Doctors and dentists can’t be expected to provide treatment and then not be paid, nor should they have to wait for 6, 8 or 12 months for payment from GEHI, FutureCare or HIP. I hear these are by far the worst offenders when it comes to non payment of claims. The doctor or dentist should also be able to obtain confirmation from GEHI, FutureCare of HIP when a patient walks into their office as to whether the individual is still covered by insurance and has not exceeded their limit. Passing legislation without safeguards can have serious unintended consequences. Beware hastily produced legislation!
In light of the expensive nature of insurance , Mountbatten refuses to put a single red cent more to a doctors bill . So sue me already .
Coincidence that this comes up now with an election imminent? Regardless, any provider should expect timely payment for services rendered and this includes those in the so called caring professions. The bottom line is that if doctors and dentists find themselves getting stiffed due to the ineptness of various schemes put forward, you can be damn sure that they will find convenient ways to avoid those patients.
At the end of the day, doctors and dentists are working in a private healthcare system. As such, if they want to get paid, they have to charge.
Those doctors who spend their time and money billing on behalf of the patients do it for their convenience (and a lot, if not all GPs at least, do this). This in itself costs them time and money! Those who haven’t been doing billing will no doubt increase their costs to cover this added burden. I’m not saying it’s right to charge up front, but this is, after all, business – not charity.
If they bring in this scheme and the insurance companies (of which the government agencies are by far and away the worst) don’t pay in a timely fashion, the doctors and dentists will simply refuse to take on those patients.
Not sure how the electorate will feel once their HIP/GEHI/Futurecare policies are no longer accepted by physicians and dentists they’ve been going to for years. Oh, I forgot, the election will have happened by then, so who cares, right?
Unintended consequences indeed…
This comment by Dr. Allington is laugable, “No one in the health care industry asks for upfront payment, which is a payment prior to service.“Some providers ask for payment immediately after providing a service.” Dr, Allington, the only difference between upfront payments and payment immediately after service is about 30 minutes. Both payment plans have the same effect. They place a serious financial strain on the consumer with or without a recession. The consumer if insured, should not have to fork out a thousand dollars for a treatment immediately after the treatment when his/her insurance covers the cost of the treatment. Additionally, the consumer has already been deducted monies from his/her paycheck for insurance. The consumer did not create the problem and should not pay adversely for the problem. If someone has to wait for payment re-imbursement, it should be the provider because in most cases, they are better resourced than the average consumer. It is not very nice when one has to wait 4-6 weeks to get his $1500.00 reimbursement from his/her insurance company. And I would assume that long waits (12 months) for re-imbursements experienced by providers was more the exception and not the rule. Surely long waits was not the experience for providers for the majority of cases. That would be incredulous! I hope the law passes but give the entities more time to implement the required systems. As an IT professional, I can hardly believe it would take 5 years to implement but the mandated 6 months for implementation is problematic.
I find this issue very interesting because it fails to take into consideration that there is no formal relationship between most care providers and the insurance industry. The patient has a relationship with the insurer and with the provider and the provider accepts the relationship between the patient and insurer but now it appears that the government is attempting to force a formal relationship between the provider and insurer. To add insult to injury it is the government related insurers that are the worst offenders when it comes to paying claims ontime. Unless the health council is prepared to force providers to see people regardless of whether these clients are able to meet the requirement of upfront payment then providers will simply not see the patient. This will escalate the issue to a whole different level. I believe that any efforts to improve claims processing is a good thing but if the health council really is concerned that people might not be able to afford the care they need then one answer is for the government to provide that care. But they already tried that with the free clinic and where is that now?
Sometimes legal matters are life-threatening: you can bet all your front teeth that our dear politicians will not be bringing forth legislation to prohibit lawyers from charging up-front fees!
Ok so I keeping reading comments about the Gov’t plans and how they don’t pay on time etc etc. YES this was def. the case. The Health Insurance Dept. was way behind on its payments to providers becuase it had a manual system (paper in boxes) and there was no way to process it all.. I know, what a mess. In 2008-2009 there was a mass clean up and providers were cut checks.. and paid for all their back claims. In 2009 the automated system came in force at HID and once in place was able to give decent (not great) turn around times. However, since the end of 2010 on FutureCare and HIP have been paying out claims within 40 days (at the most, it is closer to 25 days)… You must take in consideration what that 40 days means. This means that providers have submitted a “clean claim” i.e. – it has the correct coding on it, all the patient info. is on it etc etc. (things you would expect and are the standard for the private companies), that is when providers get paid on time and have no issues.
Now, the providers that scream and holler for the most part about late turn around times getting paid are (most times)are the ones that do not submit clean claims and they have to be researched which wastes time and money. You can ask ANY insurance company if they accept incomplete claims and they will tell you def not. But the HID does because it is a Gov’t programme and we try and help out these providers (even when they are lazy and would rather we did their work for them) On top of that you have providers that re-submit claims over and over and over again when the Gov’t has already PAID them… because they do not have sound business practice… that wastes time paying out clean claims to providers doing a good job. As well you have providers that will submit codes for procedures that they didn’t do just so they can get paid.. and think it is ok (becuase they are working the system0
So before we come down on the Gov’t health plans lets accept (and I will be the first) the their turn around time was HORRID… however it is not that way any longer and providers need to pull up their socks.
Well for once i see the peoples interests are being thought of when it comes to the upfront payment issue for health care.
As for the amount of time the vendor/client gets the remburisement back from the insurer that is what needs to be looked at as sometimes as one blogger has said is upto a years wait. When all it is a someone to do there job and push it through in a timely fashion.
In my opinion if the insurance companies(this includes Government with GEHI, HIP,FUTURECARE) held awareness expo’s to explain how to submit the documentation to recieve the claims back in a timely fashion there wont be such a backlog and there would be more time to streamline the process even further.