BHeC: Sharing Responsibility For Health Info

The Bermuda Health Council and Bernews have teamed-up to answer your questions about the island’s health care system. Visit www.bhec.bm to submit your queries and look for the response on Bernews.

Question:

I saw an article last week saying there were changes to some health insurance regulations. What does it mean? Sounds like it’s only important for medical professionals, not me!

Answer:

Enforcement of the Health Insurance [Health Service Providers & Insurers] [Claims] Regulations 2012, or Claims Regulations 2012, to which the article refers, does affect the general public. The application of these Regulations has meant better access to healthcare, but they also place responsibilities on you, the patient, your insurer and your health professional.

The Claims Regulations 2012 are best known for ending the practice of charging insured patients upfront for their healthcare visits. Instead, health professionals have to submit claims directly to insurers. In order to process these claims, better information sharing is required between your health professional and your insurance company.

This is where your responsibility as a patient comes in. The information that must be shared between the insurer and health professional includes a patient’s: name, date of birth, name of insured, relationship to insured, date of the procedure, name of referring provider [where applicable], health policy and certificate numbers, etc.

One of the key pieces of information that must be provided by your health professional is what is called the “diagnostic code” or ICD for short. These codes are key to understanding why treatment was needed and why the health professional ordered the specific tests. Referral forms must state the ICD code. As a patient, you should be able to review your referral form to ensure the ICD field has been completed.

And you will want to, because starting April 1, 2015, if information required to process a referral is not provided, a test could be delayed. You can help by bringing your ID to every visit to a private health provider or the hospital, and reviewing your referral form for its completeness.

No one wants to inconvenience a patient needing care, but these Regulations and the information they require is necessary to assist in healthcare delivery and paying for your care. For more information visit our website.

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