Hospital to charge upfront for medicine

| 19/11/2015 | 64 Comments

cost of prescriptions(CNS): Starting in the New Year, the George Town hospital pharmacy will be demanding payment upfront for all prescriptions before patients can get their medicines. Hospital officials said that this was part of the Health Service Authority’s efforts to improve collection and address bad debt but it will also undermine the principle that care will always be given first and payment addressed after. Following the introduction of upfront payments for elective surgery, the hospital pharmacy is the next department to introduce the ‘pay first’ rule in plans to phase in upfront payments across the entire health service.

The change requiring prescriptions to be paid for at the time of service will come into effect 1 January 2016.

Lizzette Yearwood, CEO of the HSA, said that the authority, like other healthcare providers in the world, is facing significant challenges meeting the cost of providing healthcare.

“Full implementation of our Payment Policy is critical to continued funding of our operations,” Yearwood said. She pointed to the slow adjustment of the wider community to the insurance-based model which was introduced in 2000.

“In the old model, care was provided to the population by the government’s then Health Services Department, which was funded by General Revenue. With the implementation of the Health Insurance Law everyone is required to have health insurance, however there still remains a portion of our population that is uninsured or underinsured,” she said, as she pointed to the self-pay population as drivers of the hospital’s bad debt.

“The HSA recognises that there may still be some individuals who need further financial assistance,”  Yearwood said, adding that qualified people may be able to seek assistance through the Needs Assessment Unit and encouraged them to watch out for public announcements on the criteria and application process.

But given the strain that the NAU is under and the limited period for which they offer financial support, this move may cause significant problems. Although this policy is a clear risk to the health, even the lives, of the uninsured and impoverished who are in need of medicines, HSA Board Chair Jonathan Tibbetts said the policy would improve health services.

“The policy has already been working well for elective surgeries in the Operating Theatre and will be phased in across the HSA,” Tibbetts said. “A healthy population is the ultimate goal for all of us in the healthcare industry. Population health is dependent on access to healthcare. Provision of healthcare is dependent on adequate levels of funding. Improving our collections will allow us to broaden our scope of services and expand our facilities. With this policy, we are calling on all residents to do their part and help us help everyone in our community,” he added.

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Comments (64)

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  1. Anonymous says:

    One of the major collection problems stem from insurance companies refusing to pay for certain services/surgeries/procedures etc after the fact.
    HSA charge the patient a % up front, the patient pays assuming the insurance is covering the remainder. When HSA submits the remainder to the insurance company, they a portion of it.

    HSA bills the patient for the remainder not paid by the insurance, they ignore the bill because they felt the insurance company should have paid it.

    HSA is left with the delinquency.

    The patient is responsible for that bill as they received the services.

    HSA has decided the patient will pay for everything up front and claim it back from their insurance company = zero delinquency for HSA.

  2. Roger Davies says:

    Well we have certainly enjoyed a “healthy” discussion on this subject!.

  3. Anonymous says:

    So sad that worldwide health care costs are so high. Healthcare should be free to all and not just for the rich. It is so hard especially when it is sick kids involved and a parent cannot afford surgery or other required health care. It takes just one major medical bill to wipe out your life savings even if you have good health insurance

    • Anonymous says:

      Then education on healthy lifestyles should be provided. Aside from a serious disease in a child such as cancer etc most sickness that children get are due to poor parenting, poor diets and neglect. Most parents don’t know, don’t care, don’t have time to provide proper care for their own children.

  4. Anonymous says:

    If you cant afford to go to a doctor don’t.

  5. Anonymous says:

    My advice to any brainwashed mug who thinks that basing a country’s health care system on private enterprise alone is a good idea is to lay off the coolaid, start wondering why everyone else in the civilised world doesn’t do it, and watch Michael Moore’s documentary on the U.S. health care system, “Sicko”. if all this makes no difference, there’s no hope for you, my poor little dimwitted (and hilariously stubborn!) friend.

  6. CaymanNurse says:

    I hope the change at the CIHSA pharmacy’s will include actually verifying the patient’s insurance and what the proper co-insurance or co-pay is. Collecting a flat 20% on every Rx just because an insurance card has been presented is pure stupidity – the ID card may be invalid, the coverage may only be 75%…. Worse for patients is that sometimes the insurance covers more than 80% and CIHSA are not showing the patient’s payment on the claims they submit to the insurance with result that the HSA then has a credit situation that the patient never is never told about or refunded the overpayment. That is fraud in my book… unless the patient has a balance owing (and many of us do since HSA have not been balance billing properly for so long), the HSA and ALL medical and dental providers should be showing what they pre-collect from the patient. This is a racket all over the island that patients in essence are sometimes overpaying with MDs and DDS’s sitting quiet with their excess funds rec’d. If they showed the sums pre-collected on their claims would be much easier on everyone’s bookkeeping I hope this is addressed in the laws and regs to help patients already suffering with high premiums and increasing medical costs. In the meanwhile, it is buyer beware – be diligent to watch what is actually paid on your claims.

    • Anonymous says:

      I am told I have to pay 100% for claims of $20 or less as they are too expensive to process. Two months later I see a claim going through my insurance company and the HSA gets paid twice.

  7. Anonymous says:

    What are they talking about?! I have always had to pay upfront my portion when I go there. I should have known that you weren’t allowed to pay upfront cuz I would have not paid a red cent til I get my bill.

  8. Anonymous says:

    If everyone was microchipped (like the dogs), then you could just have your chip scanned even if you were unconscious. You could be billed and paid before you even woke up!

  9. The Garden Of Eden says:

    They charging up front because Tony and Al have an issue with arrears.

  10. Cinic Al. says:

    I’ve continued to use the services of the hospital having long since left the Civil Service. Not once have I ever been billed.

    • Anonymous says:

      Today son, you have become a true Caymanian!

    • Anonymous says:

      But you get coverage for life along with your spouse, children, grandchildren, cousins, uncles, aunts, parents, parents in law, sons and daughters in law,and anyone related to you not listed.

    • Anonymous says:

      That is called fraud and deception and you should be charged for your criminal act.

    • Anonymous says:

      Shame on you. Dishonesty is a way of life for people like you.

  11. Anonymous says:

    Wow. I was harassed for insurance information about 45 minutes after the birth of our son – I guess it was 9 am by then! My husband was furious as he had gone to call our families with the good news (before cell phone days) and the staff (NOT the amazing maternity nurses) insisted on me filling in the forms there and then, couldn’t wait for half an hour until my husband came back.

    Of course, in the usual totally bizarre way, the forms weren’t submitted to our insurance company and we got a letter 6 months later saying health services were going to take us to court!!!!!

    No invoice, no statement, no follow through to check that they had the information – we had to do their job for them so that the hospital got the money from our insurance company.

    Nothing changes. SSDD with invoices and statements 23 years later.

    • Anonymous says:

      As with most CIG Depts and many local businesses, from a customer service standpoint, it would be courteous (and expected) if there were to be an automated invoice for co-pay amount due sent some time in between, say, delivery of services, and collection notice/threat of legal action. Email would be fine. Online or credit card payment option would be great. The crazy button gets activated far too often here at the point of first contact – very 3rd world. CUC routinely does it with their red ink Disconnection Notices when THEY fail to send invoice for a billing period.

      • Anonymous says:

        True, it’s the same with parking tickets. You don’t know that you got one (sometimes for stopping to pick someone up) until the police show up at your house to arrest you.

  12. Anonymous says:

    While something was needed to be done about the increasing dent burden, there needs to be an easy way to identify those that simply cannot pay from those that just don’t want to.

    Are the HSA thinking, “if the poor can’t pay, they will die, decreasing the number of poor in Cayman?”

    • Warner says:

      I think that’s the plan. Get rid of all the caymanians and have more of darts running around.

    • Anonymous says:

      By “dent” burden do you mean all those HSA employees that have been bashed by angry claimants?.

  13. Anonymous says:

    ..”like other healthcare providers in the world” – Ms.Yearwood, I think you mean the private companies in the U.S.A. Just about every other first world country in the world has in place a universal health care system for its population. Of course they face financial challenges, but none of them would deny a sick person the drugs they need to survive. In fact below a certain income level they pay nothing at all. The U.S. health care system (if you could call it that) is based solely on private enterprise, intent on making a buck, There only interest in healthcare is encouraging a healthy lifestyle in order to minimize their clients claims. The devastating consequences are plain to see, with persons dying and living in misery having to decide between food and drugs. Their infant mortality rate is third world. The poor have to depend on charity to survive. Their health care is no better than the rest of the first world countries, and is actually more costly. But ask the average American and they’ll tell you they have the best system in the world, the poor sods.That is until their insurance runs out and they have to sell their retirement home to pay for a life saving operation.Ms.Yearwood, you are okay. And Mr.Tibbetts, you too.. But what about those who are not okay? Do they have to suffer and die in order to provide the better (“broader”) level of healthcare Mr.Tibbett’s speaks so glowingly about? Shame on you, sir, and for all those who are prepared to turn their backs on the poor and needy.

    • Fred the Piemaker says:

      And every single country that provides free healthcare at point of use has income tax or social security deductions from wages to pay for it. In addition, the free care usually has limits on it – the drugs that can be used, the extent of treatments that can be provided, etc. Only today there is an article in the British press saying they are going to make vasectomies an elective surgery not covered by the National Health, for example, and you have to co-pay your prescriptions. And you have to wait for some time to get non urgent surgery. Here we don’t care – rock up, get what you want, HSA worry about getting paid later. And we all know how attempts to introduce certainty into payment with the Carepay card system ended up.

      The real problem here is not necessarily that we cannot afford to pay for the healthcare of the truly indigent – the government has a huge revenue stream in indirect taxes – its that we cannot or do not want to discriminate between those who cannot afford it or adequate insurance and those who simply choose not to pay for either. We cannot then tell who is genuinely deserving, or even how much a policy of catering for those people costs. We proceed on the basis of paying first and then asking later – and even then not asking too hard or checking the answers because it is somehow seen as cruel or unfair. The freeloaders get a free trip, we have no idea how much the policy will cost in any given year so we can plan for it, and tax monies that can be used on real services vital to the community such as extended healthcare for those in serious need, a decent education for our children, and proper infrastructure etc gets frittered away with absolutely no accountability.

      You can have a free healthcare irrespective of means to pay policy, but you better move to a Scandinavian tax model to pay for it.

      • WayaSay says:

        Ahm……err……Sir Piemaker, Did not Cayman have universal free healthcare for ALL it’s cotizens 40 years ago? Ay that time we had a 10% import duty and a £2 head tax and car liscenses.

        Then it was cut back to school children and Government workers and polititians and the import duty went up to 20% and we started collecting work permit fees.

        Next it was cut to Government workers and polititions only and import duties are up to 30%, we mandate health insurance for everyone and everything for businesses are taxed.

        History may be telling us that setting priorities and not higher taxes are what is driving healthcare out of reach of the poor in Cayman

  14. Anonymous says:

    For a start the Pharmacy should stop selling “gray goods” – Importing pharma from third countries in violation of intellectual property laws Cannot wait for Cayman’s new Copyright law to come into force.

  15. Anonymous says:

    Once again we are moving away from properly dealing with health care. Health care should be a right not a privilege! All first world country’s with the exception of the US have some form of universal health care and all have a healthier population than the US. Yet we insist on following the US model. As such this is another factor that leads to the rich getting richer and the poor getting poorer while the middle class disappears. It is time we respected the worth of each and every individual and not just those with money.

    • Anonymous says:

      The local insurance companies apply the US model because that is where patients go when something major happens. Reasonable people understand and take comfort in that.

  16. Anonymous says:

    Let me get this straight. A patient who needs a drug to live each day will be denied it and be referred to some kind of agency to asses his her financial standing. And how exactly is the patient’s body supposed to deal with this – die?

  17. Anonymous says:

    As an expatriate I have always had to pay upfront. The vast majority of patients at the hospital are civil servants who pay nothing since all their expenses are paid for by the private sector public. Thus very little will change at the pharmacy and there will be little change in revenue.

  18. Anonymous says:

    I was told that the hospital doesn’t enter patient insurance details into the digital patient record – because it might change – wasting patient and admin time at each visit. I am guessing that policy would make it very difficult to collect receivables after the fact if something happens to the stamped paper forms they still cling to. Getting a co-pay invoice takes months or years. Little surprise then that they are owed tens of millions. Billing should be fully automated.

  19. Anonymous says:

    For starters, they can add to their budget by having Civil Service workers contribute to their health insurance. Start there first!!

    • Anonymous says:

      Only problem would be a bigger bill for salaries to take account of this barmy “for profit” U.S. “co pay” garbage. What a load of crap. Have you ever tried to figure out all those “part A – Q” whatever insurance plans seen on the ads? (It makes figuring out your airline frequent flyer account a piece of cake by comparison.) We need universal health care – everyone pays a percentage of their earnings, and below a certain income level (horrors) nothing. Yes, I know it’s “socialist/communist” to the average “I just don’t agree with socialized medicine” type, but, funny thing is, it’s the system used in every first world country in the world. And no one is denied healthcare because it’s a basic human right. Private health care is wonderful, I’ve used it myself, and its employees are well meaning, but in no way shape or form can it every be the sole basis for a population’s healthcare provision, and anyone who say’s otherwise is not well meaning towards his or her fellow man (or woman).

    • Anonymous says:

      Of which we Civil Servants say “no problem “. We don’t mind paying. But WE MUST have a choice where to go, like every one else. It amazes me why people haven’t seen through the BS as to why we are stuck with CONICO.

      • Anonymous says:

        You would mind paying for your health insurance. It is expensive and it would cost you money out your salary monthly plus payment for services. Civil servants complain about salary all the time. There are plenty of ppl in the private sector that have lower salaries than govt workers.

  20. Anonymous says:

    Finally!! At least one area of equality for Caymanians and expats!

    • WayaSay says:

      You heartless bigot. Expats are only ever supposed to be on Island because they have a work permit and a paying job or are financially strong enough to get PR or Status. If you have a job, you have health insurance to cover your medical costs.

      There are thousands of elderly Caymanians past retirement age with no pension, let alone other disposable income, YOU would rather see these poor people die for want of their medication just because YOU want “at least one area of equality for Expats and Caymanians” ?

      RACIST, BIGOT, go home already or stay and consider yourself, and act like a Caymanian……..enough of youe stupid assed promotion of your precieved devision between Caymanians and expats………it is getting old.

      • Anonymous says:

        Wayasay, go have a long lay down, too much ganja will make you psychotic. And lets get something straight, no expat here ever introduced the farcical US healthcare system here, your own managed that. No expat ever made anyone in Cayman poor or poorer, your government gave us all work permits and deemed that we were not taking jobs away from Caymanians. The income your elected government raises from work permits, offshore fees and import revenue via all the purchases expats (as well as local people) make, is used to subsidise the unemployed, the unemployable, the elderly and so on. So if you don’t like what you see, stop blaming others for your horrific voting mistakes and start voting people in who can actually change something. Us leaving will just make the situation worse, like it or not.

        As for your ranting, there was no racist comment in mine. Just fact. Ex pats have to pay in advance and always have. Fact.There are two sets of rules, and expats are always worse off than Caymanians, and charged more, forced to pay for things that Caymanians don’t have to, which is technically illegal under various international conventions. And given that you have this advantage, some of you even then manage to screw it up totally.Watch this space for law suits, in fact they already starting. And then you want us to all buy your damn raffle tickets, donate to this and that and supporting everything because you cannot vote in a government that can get it right, which actually means you cannot get it right?

        Get a life, get rid of the lodge, get some decent, intelligent people with long term interests of Cayman at heart running the place and you might recover. Expats have absolutely no say in your choice of government. Fact.

        • WayaSay says:

          Anon 2.36. I will take your informative advice about ganja at face value as I am certain that you have the experience to justify your argument. I am certain that you have more experience than me, hence your sage advice.

          My post did not, and I have never posted nor suggested that expats are taking away Caymanian jobs. Indeed my indignation stems fron the fact that YOU in particular did and continue to argue that Caymanians and expats are two different animals living in the same cage.
          The door of the cage is open and you can leave if it is so burdensome for you.

          If you chose to stay, as you obviously have, then shut up with the wining and live like a Caymanian………..we give a damn anout our elderly and poor who are falling through the farcical IS healthcare system that was foisted upon them, with NO Safety net in place.

          Your ignorance is glaring regarding work permit fees. The $89m paid by expats, around 12% of the annual budget, depending on whose numbers you believe, goes to build things like unnecessary cruise docks, NOT to provide a safety net for the elderly and poor.
          IF even 10% ($8.9M) of the work permit fees were used to set up a safety net for these elderly and poor citizens, they would not have to go without their medication or choose between food or medicine. Get over your bigoted inferiorioty complexed self already.

          If you have an employer paid health insurance that makes you pay up front, I suggest you speak to your employer or do what Caymanians like me do and pay the difference for better coverage………just don’t ask the elderly or poor to go without their medication because you have an inferiority complex.

          I do agree with your rant about Caymanian polititions………..the difference is that I am trying to do something about it instead of posting bigoted stayements on CNS.

          I do disagree with your statement about if you leave it would make it worse…..your leaving will concern me as much as a gnat jumping off an elephant’s ass. I would respect you more if you took the ignorant polititions with you.

          The rest of the expats without a chip on their shoulder, as you obviously have, and who actually make an effort to assimulate into Caymanian society, are welcomed to stay forever, or leave at their own choosing.

          Now pick back up your ganga spliff, take a long draw, and chill out……….. I do not need you dictating to me what to do about Cayman politics as you are useless in my efforts to bring about change.

          • Anonymous says:

            Oh dear, another one who just doesn’t get it. Financial services and permit fees account for some 64% of CIG income. Tourism 20% and the rest import duties and so on, of which roughly half is paid by expats. So as we jump off your large smelly elephants arse figure how you are going to find the 72% of current CIG revenue to keep your welfare checks coming. Now do you get it?

            • WayaSay says:

              Why are you lumping Financial Services and work permit fees to come up with your 64%?
              Every business who hired expats , pay for work permits and that totals to $89M……. about 12% as I stated. (How do you jump to 72% anyhow…do explain)

              YOU are not the Financisl industry in this Island, so get over yourself……gnat.
              Go ahead…..jump.

              By the way, they allow money laundering in London and New Jersey so you should be able to find a job in one jurisdiction or another…….or do you not have friends or family there to hire you?

              The expats who truly like Cayman will be here long after you are gone….and be welcomed by Caymanians.

              • Anonymous says:

                Forgot my own lesson, pointless arguing with a rabid dog. Best just to put it out of its misery.

      • Anonymous says:

        Ha! “you have health insurance to cover your medical costs.”
        That’s a joke. Have you seen some of our ‘health care’? Ours tops out at $400/year (rx drugs, dentist, eye exam, wellness, etc. are all in there) and the tests cost double what they would in the US. Trust me, we’re paying for our health care.

        I do think you should consider xanax, though. If that’s not too heartless. You seem to be a bit on edge.

        p.s. the US has a system for the elderly; it’s called medicare and it actually works better than people think assuming you don’t depend on it for all of your care but actually put a little money in savings while you’re young instead of spending it all on rims or 345. Just sayin.

        • Anonymous says:

          You’ve a terrible health insurance plan of it tops out at $400 for those services. Speak to your HR dept to see if they can negotiate a better plan for your company.

  21. Anonymous says:

    I wish I knew this – they have always insisted on payment up front with me so this is news to me!

  22. No job, No Health Insurance - Death to You!!! says:

    Instead of “hating” one person’s helper, as we really do hate low paid, black Caribbean people and OTHER low income workers – who by the way we CAN’T live without, that is, our Helpers, Office Cleaners, Gardebers, etc., you might ask – What happens when a CAYMANIAN adult or child shows up at the hospital at night ( or day) and DIES because they have NO job, NO health insurance, NO money. Should they just go home and die? Think about that. It’s a Government Hospital. So we can give Turtle Farm $10 million for a business that should be privatized, give Cayman Brac $ millions , waste $ millions on Cubans, and the list goes on – BUT LET THE POOR ( who paid taxes by everything they consumed) DIE!!!
    Shame on you. I pray for Hurricane Ivan’s SIster or Brother to come back and visit us, as we are have lost our way again!!! And I forgot the “God Fearing” lie that we use as our justification when we need help.

    • Anonymous says:

      Praying for the death of others is certainly not a Christian act.

    • Anonymous says:

      Health Care is only free when you work aka: waste time for the Government.

    • WayaSay says:

      AMEN I could not agree morr with your comment.

    • Anonymous says:

      Get the stats on US hospitals. Find out how many die waiting to be attended yo when they go not have money or health coverage?
      They should’ve stopped all of those people who come here and get free medical that they cannot get in their countries, not later but years ago. They bring their children as well and suck up all the freeness, especially during the summer months. Put a full stop to it.

  23. Anonymous says:

    The Pharmacy is the only profit centre at HSA. Cannot wait for whistleblower bill to be passed!

  24. Anonymous says:

    Ha ha ha. It’s the fall of communism.

  25. Anonymous says:

    I’m glad they are making this step… I literally knew of a friends helper who declared she was not going to pay for having her baby at the hospital months ahead of time. it’s a known thing that you can just show up and not pay…….

    • Anonymous says:

      And yet I bet immigration keeps renewing her permit despite the fact she owes government money and refuses to pay.

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