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Doctors snub review of medical fees

| 17/11/2016 | 34 Comments

(CNS): The government has confirmed that fees paid to doctors for health services won’t increase in the short-term after most local healthcare providers failed to engage in a survey to review medical costs that could have seen them get more cash. The results of the work by medical consultants engaged by government indicate that the man in the street will soon be paying at least 12% more for health cover if the local health system is not fundamentally changed, as the consultants found fees are too low to cover costs. But with less than a quarter of healthcare providers taking part in the review, Cabinet said it is not prepared to make any changes yet.

On Thursday, the health ministry released a report by Morneau Shepell, the firm contracted in May last year to carry out a survey to review healthcare provision and insurance fees to determine the costs associated with operating a medical practice and billing procedures. It was meant to give government information to justify an increase in fees if needed.

While the consultants have recommended increases in various fees, which would result in an overall 12.3% rise in costs across the healthcare system, officials said Cabinet has decided to postpone any increase in fees until doctors engage in the process. It now plans a another review next year, for which it hopes to persuade more physicians and other healthcare providers to participate so that meaningful conclusions can be drawn on the data.

Out of the 139 physicians and 67 health practices contacted, only 50 responded and not all completed the survey. Less than 10 of those 50 who responded provided financial information to the consultants to give an understanding of the cost structure for operating a medical practice.

“This made it extremely difficult for the consultants to have a high degree of confidence in determining a reasonable level of cost of operating the medical practices,” said the councillor in the health ministry, Roy McTaggart. “As a result, it was very difficult to establish a fair level of fees for services provided by the healthcare provider. We commend those healthcare providers who did respond to the survey but unfortunately it was not sufficient.”

As the Standard Health Insurance Fees have not been increased for many years, government said it is still willing to review the fees again next year if providers fully participate in the survey at that time.

“We need the healthcare providers’ cooperation to do this as we can only determine a fair level for the fees based on the information they provide us with,” said Ministry of Health Chief Officer Jennifer Ahearn. “We urge the healthcare providers to be forthright in providing this information, which is held in strict confidence by the actuaries conducting the survey, so that we can work with them to ensure that a fair level of fees is implemented.”

Standard Health Insurance fees are the list of fees approved by the Health Insurance Commission that an approved insurer is liable to pay under the Standard Health Insurance Contract for a healthcare benefit provided to a compulsorily insured person. Under the law, every healthcare facility and registered practitioner must file with the Health Insurance Commission annually the maximum fee charged for each health benefit provided by the facility and the registered practitioner.

But the current system operating in Cayman is coming under increasing criticisms from all sides except for insurance providers. Currently, insurance costs for most people are becoming prohibitively expense but the law mandates everyone must have health insurance.

While government and most public authorities pick up the full tab for comprehensive insurance cover for its employees, most workers in the private sector are less fortunate. While professionals and management may work for firms willing to also cover their costs, workers who are fortunate enough to have bosses who follow the law and provide cover are still required to pay half of the premium and in addition are often faced with deductibles and additional non-covered costs when accessing medical services because of the inadequacy of the SHIC plan.

Insurance firms have also been in the habit of declining cover to people with pre-existing conditions, leaving the government’s own insurance company to cover those individuals indebtted to the government hospital.

See the report in the CNS Library

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Category: Health, health and safety, Health Insurance

Comments (34)

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  1. Anonymous says:

    At present there is, it would seem, no one happy with the system. It is outrageously expensive and does not deliver what is needed. There are good doctors but they are trapped in a rip off machine that is just spiraling out of control.
    Europe gives mostly free healthcare paid out of taxes. Clearly we don’t have taxes, except I see the premiums that I and my employers pay as an exorbitant tax.
    A very little rough math- if we all (and I mean all) paid $200 per head per month for each man woman and child into the system, and pensioners and the disabled paid less, in my book there has to be at least a $125m fund to pay for health services annually. Is that not enough to fund a state medical system? Doctors work on salaries but are also allowed to practice privately for a day or two a week for those that can and wish to pay more. I am sure there are some enterprising insurers out there who could come out with a product over and above the state product for the Med Evacs and U.S. treatment that is sometimes needed. It would save a huge amount of money for all, and we could concentrate on one major medical centre to provide all needed facilities.




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  2. anonymous says:

    The irony of health care. Just 2 examples. A person has MS and his insurance pays $12,000/mo for injections. The lucky person have found a dictor who switches him to a different medicine, LDN in particular, that cost $28-44/MO and prepared by a compounding pharmacy. His insurance is refusing to pay, stating that compounding pharmacies not covered. Mind blowing.
    Now try to get LDN prescription from any doctor. The medicine is known to help from cancer to MS, from allopecia to autoimmune diseases, from infertility to chronic pain, and is FDA approved. Good luck.




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  3. Anonymous says:

    Let’s get a few things straight:

    1. Doctors did not “snub review of medical fees.” They snubbed the unnecessary and highly intrusive financial survey that would have exposed the private and confidential business financial information.
    2. The government has chosen to ignore the report provided by a group of medical consultants engaged by them to look in doctors’ reimbursement from health insurance companies, which recommended a 21.3% increase. This does not meant a 12.3% increase in premiums. The insurance companies can choose to absorb all of some of this increase for the benefit of their customers, which brings me to an important fact:
    3. While, over the last 10-years, health insurance premiums have gone up by around 400%, the amount paid to doctors by the insurance companies has remained exactly the same– a 0% increase. That’s right, doctors haven’t had a pay rise for over 10-years! So, who’s making out like a bandit? It’s certainly not the doctors, who have absorbed the increased cost of rent, utilities, equipment maintenance, clinical supplies, malpractice insurance, etc. How would you or your business be faring if you hadn’t had a pay rise for over 10-years?

    If government doesn’t support a fair and realistic increase in the fees paid to the doctors by the insurance companies, the quality of private medical care in the Cayman Islands will suffer as doctors struggle to maintain and develop their medical facilities.




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    • Anonymous says:

      Whilst the “standardized medical fees/expenses” covered by insurance has not been increased for 10 years, that does not mean that doctors have not raised their fees over the last 10 years. I have found this out the hard way over the last few years by constantly having to foot the difference over what insurance deems as a standard rate and what the doctor actually charges. There is a huge difference between what some doctors charge for the same service and most patients only find this out after they have gotten the bill. Most people do not go “doctor shopping” based on their rates as the doctors don’t even know prior to the exam what they end up going to charge as it depends on what is needed during the exam itself.

      I am very grateful that I have a very good health insurance which is paid for by my employer but my employer has to dig deep into their pockets to pay the premium every month! It is crazy that some doctors are charging CI$ 300 for a office visit that at times end up being less than 15 minutes!

      What is even more concerning is that so many doctors and dentist refuse to take the insurance cards and deal with the insurances which I thought by law they must, however, there seems to be a loop hole in the law.

      That said, I agree that many insurance companies just take the piss and sit on claims for ages. This nonsense must stop!




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      • Anonymous says:

        18/11/2016 at 1:54:

        The full list of standard fees is published here: http://www.dhrs.gov.ky/portal/page/portal/hrshome/hic/Standard%20Health%20Insurance%20Fees

        Although it’s not illegal for doctors to charge more than the standard fees, very many choose to adhere to the standard fee schedule. So, it’s easy: Ask your doctor what he’s going to charge for a particular service (e.g., an initial consultation), ask for the CPT code for that service and look it up at the URL given above. If you think his or her fee is too far in excess of the standard fee ($300.00 for a 5-min consultation is most certainly high) then find another doctor! There is certainly plenty to choose from.

        There is no loop hole in the law. Doctors and dentists are obliged to attempt to reclaim fees from insurance companies if they are presented with a valid insurance card. Again, if a doctor doesn’t want to play by this rule, find another doctor who will!

        Please appreciate that although your health insurance premiums have risen by around 400% over the last decade, doctors have seen none of this. They are being reimbursed exactly the same as 10-years ago. As you can imagine, the cost of running a medical facility has increased dramatically over the last 10-years, which is why some doctors feels they have to charge more that the standard fees to stay in business — but certainly not all of them. If you want to pay standard fees, shop around for a medical practice that can confirm they adhere to the published schedule.

        Finally, ask yourself this: If insurance reimbursements to doctors have not risen a single cent over the last 10-years, why has there been a 400% increase in your premiums over the same period? Where’s all this money going to?




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      • anonymous says:

        I just had an examination by a doctor in Florida which lasted 3.5 hours and included 3 EKG, breathing test, numerous BP and HR mesures in a standing and supine positions, stethoscope was applied not only to my chest, but neck, legs veins, etc. , blood flow was ckecked with doppler, Everything in my body was thorough examined, including neurological tests. All in the same office by the same doctor. I paid $350 and was given a diagnosis. I have no medical insurance. This is what a new patient examination supposed to be. Not a 15min. visit to a doctor in Grand Cayman who quickly diagnosed me as having an anxiety and charged CI300. She is in a private practice now.
        There are bigger issues exist than the doctor’s rates. The main issue is what should constitute a new patient examination, certainly not a quick look at you and huge bill. Doctors must be obligated to conduct a thorough examination, check list examination so to speak, before they can charge a new patient fee.




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  4. Anonymous says:

    Considering my doctor’s office has a prominent notice stating that, due to the failure to increase fees, an extra fee is charged, it really makes no difference to them one way or the other. You either want superior health care or you don’t. But the difference between what is economical for doctors and what the government allows comes out of voters’ pockets when it should come from the insurance companies that we are all forced to use. Perhaps the government should ask doctors why they didn’t participate – it might be because we have the sickest population we’ve ever had in a number of ways and all medical professionals are oversubscribed, hence a rationale for increasing the fees payable to them without a lot of hand-wringing or patient-wringing. Just my two cents.




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    • Anonymous says:

      The reason why Doctors did not participate was the totally unnecessary and intrusive survey. Perhaps an instrument deliberately employed to scupper the review?




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  5. Anonymous says:

    Private doctors likely snubbed this because they are already charging more than the approved government rate for service. They simply charge the patient the difference.

    I’m told we are 20/80 however the insurance only approves 60% because that is the number that is the government pricing list. The patient pays the 40%. Frequently after paying my 20% I’ll get a second invoice on an item because the fee was higher than covered.

    Why would private doctors rock this boat?




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    • Anonymous says:

      18/11/2016 at 7:30 am: This is misinformed nonsense.




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      • Anonymous says:

        Please inform us.




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        • Anonymous says:

          If your policy states 80/20, the insurance company is obliged to pay 80% of THE STANDARD FEE, not the sum being charged by the doctor. Of course, if the doctor collects just the 20% copay on a higher than standard fee, this will leave a sum outstanding. However, most often the doctor will add the “uplift” to the copay at the time of service.

          Having said this, even if the doctor charges standard fees, the copayment you make at the time of service may not the final sum you will be asked to pay. Unforeseeable by the doctor in advance, your insurance company may not reimburse for certain aspects of your care; or will reject reimbursement on the grounds of a preexisting condition; of you may have maxed out your annual benefits, or the billing clerk may have missed a deductible due at the time of service, which becomes the patient’s responsibility to settle at a later time — usually after 60-90 days, when the doctor receives only part payment from your insurance company along with an explanation.

          The bottom line is this: If you’re unhappy paying over and above the standard fees, find a doctor that sticks to the published fee schedule. There are lots of them out there. My doctor sticks rigidly to the standard fee schedule.




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    • Anonymous says:

      You’ll get a second invoice because your insurance company didn’t cover certain aspects of your care. Before you blame doctors for overcharging, check with your insurance company to discover the truth.




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  6. SELF-INSURANCE ONLY WAY to GO... says:

    In my early 20’s I had already come to the conclusion that both health insurance and pension contributions were pure scams…

    On average, if you pay $1000.00 to a health insurance company, you’d be lucky to receive $200.00 back towards your medical costs: the rest is spent/wasted in various overheads, commissions and profits…

    As for the retirement age, it keeps on being pushed back, the retirement funds are often mismanaged and since fewer young people enter the labour pool to support pension payments to retirees in the medium or long term, most pension funds will go belly up sooner or later: it really reeks of a pyramid scam…

    The answer: self-insure – which means you may also have to be self-employed – and build your own insurance/pension fund with the contributions you would otherwise pay-out to insurers. Invest the funds wisely and somewhat conservatively, so that you’ll soon have a tidy sum to meet your health expenses…

    I have done that all my active life and in spite of having to fight several cancer episodes, I find myself way ahead of the game at age 70. I have the freedom to look around and pick the highest quality hospitals at the cheapest price in countries like France or Holland and pay 1/4 of the costs that would be incurred in Cayman or the US…

    In fact, Cayman should be avoided at all cost if you have any serious health issue, as for example, a simple MRI can cost you US$3000.00, compared to some 230 Euros in Europe and US$450.00 in the US…




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  7. Anonymous says:

    The medical profession has not provided any scholarships for Caymanians to attend medical school. Also the Local Companies Control Law does not apply for Health Care Facilities….why the exemption?




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    • Anonymous says:

      Agreed. And all those big fat concessions should have actually been used for scholarships…..especially with all the 2 Billion dollar chatter….




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  8. Anonymous says:

    Please do not increase the medical fees, we can hardly afford it as it is. I had to go on CINICO after retiring and could no longer afford the CIDlrs 1200 per month that my company was paying for me. I now pay About half that amount per month and hardly have any benefits. Still have to go to a private doctor and dentist because the doctor that I would like to see at CIHSA works part- time at a private clinic and it is very difficult to get a timely appointment with her. I knew that the benefits would be reduced but had no idea that it would be non- existent. I think the government should proceed to morph Cinico into a proper insurance as was invisage at the initial stage where everyone ishould be enrolled to make it viable. If those who can afford want private insurance then they can take out additional policy. CInici needs to become the national insurance of the Cayman Islands. As it is now, only retired persons, Civil servants, indigents, low/ income, and prisoners are enrolled. The pool is too small so therefore the cash flow is diminished. Afterwards private doctors and clinics should also be allowed to accept and honor the CINICO card. If government really want to make the insurance/ health problems a




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  9. AladenCare says:

    Got to love visiting the Dr., settling up with the cashier and being told you’re all paid up only to receive an additional invoice in the mail! Literally nothing pisses me off more.




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    • Anonymous says:

      When this happens again, check your policy to see if the service you received is actually covered, or if you had a deductible to meet, or if you have maxed out your policy for the year, and then contact your insurance company to ask them why they did not pay the claim in full.




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    • Anonymous says:

      The copayment you make at the time of service is OFTEN not the final sum you will be asked to pay. Unforeseeable by the doctor in advance, your insurance company may not reimburse for certain aspects of your care, which becomes the patient’s responsibility to settle at a later time — usually after 60-90 days, when the doctor receives only part payment from your insurance company.




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  10. Anonymous says:

    Jeez, how can they not earn money on what they charge? It’s outrageous




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  11. Anonymous says:

    As long as we look at health care as a product you can buy (US), instead of it being a right (Europe), it will become more and more expensive.
    The winners will be the doctors and the shareholders of insurance companies.
    A government should regulate.




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  12. Anonymous says:

    medical fees like everything else in cayman are beyond belief…all supported by the health insurance scam industry…..
    $200 to talk to a doctor for 5 mins????




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    • Anonymous says:

      I suspect that the government want to up the fees at the hospital and their clinics hence the review. The private doctors don’t care much because they charge whatever they feel like. Before doing any review and upping any fees government needs to regulate the insurance companies and fix CINICO so they will cover a hill now and then.




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      • Anonymous says:

        This is not about what the private doctor’s charge, it’s about how much the doctors receive from your insurance company, which is a set fee structure. Health insurance premiums have risen by around 400% over the last 10-years. Guess how much the reimbursements to doctors have gone up? — Zilch. Nada, 0%. So, if the doctors are being paid the same as they were 10-years ago, where’s the 400% increase in premiums going?

        Understand that if the doctors receive a little more from your insurance company, you may pay a little LESS in “indirect charges” made by some doctors to prop up their cash flow to keep their clinics open.




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    • Anonymous says:

      It cost me $185.00 for someone to come out to look at my fridge/freezer, and I recently paid $400.00/hr to see a lawyer. Considering the amount of training a doctor goes through $200.00 for a consultation is a bargain.




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      • Anonymous says:

        Really? Compared to a lawyer, who can’t say ‘take two and call me in the morning’ but must, in the client’s presence and not, find the solution and ensure it works? Only if your consultations last longer than half an hour is a doctor less expensive than a lawyer at the rates you give – when is the last time a GP gave you half an hour, let alone 15 minutes sometimes? To say nothing of the relative value of the services provided, which can’t be compared except to note that we need both healers and keepers of good order – doctors and lawyers respectively. Doctors do go through a lot of training; they also have the most exclusive domain of professional knowledge – that about the body, most of which is a mystery to lay people – practically forcing you to care for yourself through their agency. Every other human being is a patient waiting to walk in, including other doctors! Countries also educate and train only as many doctors as they need – thousands of would-be lawyers are lined up at the starting gate in countries around the world every year, a fraction of them make it into the lowest levels of the profession and a further fraction of those actually succeed and earn a permanent place in it. When was the last time you met an unemployed doctor? Give me a break – pay them more, sure, but not with my money. As the poster above says, the insurance companies should be paying more of those inflated premiums to the people doing the work of keeping people healthy and if the government has to see that this happens then they should be doing it yesterday.




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        • Anonymous says:

          My doctor always spends at least 30-minutes with me and charges me the standard follow-up consultation fee of just over $100.00 dollars. If your doctor is spending less than 15-minutes and yet is charging a huge consultation fee, FIND ANOTHER DOCTOR!

          Pay doctors more “. . .but not with my money” is more than a little naïve. Do you honestly believe that when doctors do eventually receive a small increase in the reimbursements given by health insurance companies your premiums will stay the same? Do you really think health insurance companies will absorb this cost because it’s been covered by the 400% hike in premiums over that last 10-years? Not in a million years. They’ll shout “foul” and blame greedy doctors for the increase in your premiums. The insurance companies will make YOU cover the cost whether you like it or not. In fact, your premiums are likely to go up another 400% over the next 10-years whether doctors get a little more in reimbursements or not.




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      • Anonymous says:

        @12:25 pm
        if they provide value for $200. Once doctors get their license to practice they forget everything they have learned in a medical school including ethics. They seem to have one diagnosis for all and one medicine for all. You either have anxiety or GERD. And they “diagnose” you in just 5 minutes. And if you keep coming back with symptoms they send you to a psychiatrist.
        If you paid someone $185 just to look at your fridge, that is your problem.
        When you pay $400 to a lawyer you get real value in return.




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        • Anonymous says:

          Spoken like a true, cynical, intellectually dishonest attorney that just wants to bait rather than engage in a worthy discussion.




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  13. Anonymous says:

    Government have been dragging their feet on this issue for more than a decade. If Civil Servants had to pay for everything like the private sector you can bet they would not have been sitting on it.




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