Hospital backs off aggressive debt collecting
(CNS): HSA Deputy Chief Executive Officer Ronnie Dunn has confirmed that although the Health Services Authority has retained the services of a debt collector, they have been asked not to act aggressively against those who are struggling. While the bad debt problem has not gone away, the HSA is writing off much less now than in the past and there have been improvements in efficiency and service provision, which has increased revenue. Therefore, the need to squeeze cash from those who can least afford it is not a priority.
Speaking to the media on Wednesday, Dunn said that government has been wary of being too aggressive in pressuring those who are struggling with insurance cover. He said the debt collectors have been asked to limit who they pursue, focusing on debts that they are likely to recover, such as those run up by patients from cruise ships.
“We have to remain sustainable but we can’t be naive about the fiscal realities,” he said, noting that many people here still have inadequate cover for the care they need.
The cost of healthcare is rising everywhere, including the Cayman Islands, where last year’s consumer price index showed it had increased by around 12%. However, Dunn said the HSA was well aware that the cost of healthcare was a significant issue for people and they were striving to reduce this.
He said they were focused on filling the gaps in provision across the islands and making access easier for all by investing in infrastructure and services and cutting operating costs.
The hospital this year embarked on major investment in around 35 critical infrastructure projects of varying scope and complexity with a budget of CI$8 million, the largest single investment since the inception of the HSA in 2002. This covers a wide range of new services, from the provision of a dialysis service at the West Bay Clinic to a new ambulance centre in Bodden Town.
In addition to replacing the fleet, the new EMS base was desperately needed, not just to deal with the increasing calls from a growing population but to help cut response times, which have been dramatically impacted the traffic congestion.
Dunn said the solar panel project at the George Town hospital site was calculated to cut at least $360,000 per year from the HSA’s power bill, the equivalent of five new nurses. And that was before the cost of energy soared, so expectations now are for even greater savings. There are also plans to expand the rollout of solar panels on other parts of the estate, including covered parking.
The deputy CEO said that the hospital had now found a way to make sure the money it has was going where it was needed and was balancing investing in the right places, while helping to keep the cost of healthcare provision down.
HSA Board Chair Osbourne Bodden noted the strategic vision for the government hospital in the next few years and explained how the main aim was to make sure the hospital was not competing with the private sector but was filling the gaps in provisions.
“After decades of cash flow challenges impeding needed investments, the HSA embarked on an ambitious infrastructure development programme in 2021 to ensure our world-class healthcare staff have world-class facilities to continue delivering cutting-edge care,” he said.
“We have been making and will continue to make significant investments in new infrastructure and capabilities that will position the HSA to improve access to care and the health of our people,” Bodden said.
He said the proof that the HSA has been successfully improving the experience of patients and families was in the revamped patient experience survey measured independently by an international agency. Bodden said that of the 21,439 people surveyed in 2021, 83.5% ranked the quality of care positively, with most stating it was excellent.
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Category: Health, Medical Health
With no disrespect. This is what happens when the people in a country sell it out. Over burden it with alot of ready made families, give away caymanian status like candies too people that were poorer than or poorest locals that come from countries with higher crime rates. It caused and will continue cause a culture shock that our cayman islands will never shake out from. Hard, drastic and mandatory laws must be put in place in an a emergency, utgently right away. Such as work permit holders only can get three to six months work work permit and after the permit finish they must return too there home and must not get a work permit until another six years. And who are now on work permits when their work permits are finished they must return home on roll-over and must not return until eight years later. And who have caymanian status must not have ownership too any type of housing, property or business until forty years after they have being issued with a caymanian status even if their spouse are a caymanian
Earth to Ronnie, what’s the first thing you’re asked when you go to a health provider? Do you have insurance coverage and in the case of cruisers or stay over tourist the answer would be no. So, you pay by CC and submit the paid claim to your carrier in the states. So the comment, “ He said the debt collectors have been asked to limit who they pursue, focusing on debts that they are likely to recover, such as those run up by patients from cruise ships.” Apparently HSA doesn’t ask the relevant question to cruisers. Is anyone surprised 😮 You can’t make this stuff up.
He was more driven by the desire not to offend anyone local who might complain about being asked to pay their debts, or the insurers who after the event announce that the are only going to cover part of the costs, than the practicalities of recovering the money. If that’s going to be the policy they should simply write it off.
I’ve never been allowed to leave hospital without paying in the 12 years I’ve lived here, oh wait I’m not Jamaican.
I always pay, however I question your “never been allowed to leave”. Really? Who stopped you? Nobody. No security guard said, “you can’t leave without a receipt showing you have paid.”
I am not saying this to challenge you, but to point out a primary weakness in the system. When there is an appointment, get payment or insurance up front.
I guess I am challenging you, because of your “Jamaican” narrative. You think only Jamaicans can walk away without paying? Your hubris is showing.
I agree, but would also point out that getting insurance up front doesn’t work when, even with a pre approval, the insurance company decides after the fact that they wont cover some elements of the costs on the basis that the charges exceed what they, an insurance company not medical professionals, deem necessary.
I’m American, working on a government contract. I have never been asked to make a payment when leaving government hospital services.
10 @ 7:28 pm – and I’m a Caymanian, retired from the public service after almost 40 years service and I have to pay 20% of my health care at HSA (my insurance pays 80%), including a current $8+k bill for services rendered. I’m required to pay every time I get treatment or a prescription.
Sorry, but I can’t consider that my treatment is fair, compared to yours. But then again, I’m sure you didn’t make those arrangements, your inept bosses in the government service did.
Double standard much??
They can’t refuse a Caymanian medical treatment. There is no need to pay.
says who?…..where is that crap from? SHow me what part of the Law says you cant refuse treatment for locals?
Its more like: emergency medical facilities will not refuse anyone emergency care. But they will try to get you to pay after the fact.
So walk in with appendicitis, go straight to the operating room, get the bill in the mail and the debt collector call after that. Walk in for a tummy tuck and get asked to pay up front. (Or at least for your insurance card; but that’s a separate part of the problem.)
The misperception is that the HSA is (mostly) for either emergency or other necessary services. So when you need their service, even if you can’t pay, they kind of do have to treat you or you end up dead, and that’s bad. Hence the perception that they can’t refuse people medical treatment. (More so if they’re Caymanian because while foreign nationals can hypothetically be sent home for necessary but not emergency coverage, Caymaians can’t go anywhere else than HSA.)
The Deputy CEO says “they have now found a way to ensure the money they spend is going where it’s needed”!!. Can anyone think of a better example of our world class civil service in action?.
It’s a SAGC not civil service.
Fix the failure to collect treatment fees at the date of service . . . Hello? (knock on the head). Bet you this hasn’t been addressed!
All of government authorities need to go back to cinco stop wasting money with private insurance companies … reinsurance with a bigger provider in the UK or USA…
Hsa has upped their game now i noticed….doctors even referring patients….perhaps because section 12 was repealed and they can be sued now..keep up good work…
How many of us have left being told we are fully paid up but are being chased now. They keep sending me a bill for 7 dollars. 7 DOLLARS.
So pay it. It’s SEVEN DOLLARS, so not going to cost you an arm and a leg to do the right thing.
hey, remember that time you bought groceries three years ago? We just decided it was actually more than what we told you it was. You need to pay us 7 more dollars.
Cost them $700 to try to collect.
If they dont collect, it will be them (CIG/HSA) who are struggling…
Seems like its some kind of facade by HSA to write down lots of revenue on some ‘moral/ethical’ pretense.
Consumers need some protection too. Digicel cuts off post-paid consumers with $1000 deposits because they can’t reconcile customer payments against post-paid balances in real time. CUC does the same. Consumers need to have someone fighting for them, instead of the default being that customers of 10 or 20 years are suddenly, in the span of 24hrs, scammers and criminals, due to corporate reconciliation issues! Treating customers with some dignity and appreciation would be a nice starting point.
Maybe pay your bills when due instead? Then you won’t have to worry about real time reconciliation for payments you’re making for something due weeks ago…
I have been hounded for a $1100 bill I PAID for 6 years. I was escorted to the payment window before hospital discharge. I have provided proof with bank statements showing transaction number and payment (paid with debit card), been threatened with court action and the last part was the funniest, they wanted me to sign a consent form to access medical records! In the early days before HSA engaged the debt dogs, I spoke and emailed their accounts several times, told it was an error and it would be corrected. So tired of this now it is just not funny, I should sue for mental stress and bullying.
7.52am If you think their Finance dept is a mess now wait a while. They just hired the CFO who decimated CIAA finances and couldn’t hack it at Public Works.
But a Caymanian, nuh true 5:57?
10.41am Nope. Jamaican. They rule at HSA
Seems like this new board is taking credit for things done by the prior board. Too bad they aren’t actually going to be able to afford it if they don’t collect the money owed. $100 million on the streets is a lot of money.
$360k? LOL. Would need about 1MWp or 3000 panels to save that much!
Agreed, CNS misquoted, the savings arise from new chillers, LED replacements throughout, new thermal efficient windows and the solar panel installation.
They once told me they wouldn’t cover a surgeons assistant..
According to them, surgeons don’t need assistants when opening someone’s face and removing parts of it; they can do that on their own.
That was from the medically qualified insurance representative who was in car sales 4 months before becoming my insurance rep.
And they told you that after the surgery, right? Same as they decide that charges for treatment and medicines are inadmissable because they don’t match their big boys book of medical costs, based n who knows what source but clearly unrelated to the actual cost of treatment on the island.
Don’t even get me stared. Government needs to reform the health insurance system immediately. Private coverage is virtually impossible to access and prohibitively expensive. Only big companies and GOVERNMENT have decent health insurance. And the private companies kick you off the policy at 65 when you need it most. And guess what happens then? Cinoco (government) steps in and pays. It’s wrong on so many levels.
– ban pre existing conditions exclusions
– ban age caps on private insurance
– save Cinoco by making private companies pay for covering older people.
– audit and control premium much like CUC.
– institute a cap on profit
That would be a good start.
Isn’t that what Chris Saunders claimed he was going to do…..if memory serves that’s all he talked about in the years leading up to the elections…
Well, what DID he do?
Agree. If our health care system worked, HSA would not have to squeeze us dry. In a perfect world, CINICO would be nationalised, available to everyone, such that the broad base would realise less cost and more coverage to the individual/family, and that we all could get the same level of coverage as CIG employees.
THAT would be a place to start, and hope to improve upon. My premium only pays for catastrophic care, and everything else is out of my pocket. I am of age, but can’t retire, because I have to keep producing to pay for whatever comes down the pike heath-wise. This is a broken system.
Unfortunately non-payment of HSA bills is a form of nationalised healthcare here.
I am one of those people approaching 65 having worked all my life and made very few claims. I was in hospital only once for 3 days. I have always paid my premiums and find myself now facing no coverage. Certainly doesn’t seem fair, I am not a wealthy person and will not be able to pay for insurance with my $1000 a month pension.
Another CIG Boondoggle, $100M in receivables that will never be collected.
That’s not what this article is about. Sending the most basic invoice advisory, even via patient email on file, ought to be the first initial step long before appointing debt collection agencies. Give it a beat, then escalate, like normal rational service agencies might. It’s possible the patient is disputing coverage with their insurer. HSA and other service providers on island, skip critical steps, and default to DEFCON 5 too flippantly. Insurance companies can and DO often make aggressive mistakes on patient coverage. Qualifying them as mistakes, is perhaps being too kind. There is no consumer watchdog looking out for the little guy.
They have been dealing with this for years. They brought in a third party to collect long overdue debts and they were actually effective but the “voters” didnt like it so we are back to square one.
No, do not back off. The work permit holders need to be held accountable. A large portion are crooking the system and now expect the CI to pick up the tab.
How it should work is that if you have a debt at HSA. And depending on how large,and how long the debt been there, then it should be tied to your work permit.
Why is it that almost any subject mentioned triggers finger pointing at work permit holders? Any problem some of you see is a work permit holder’s fault. Unbelievable.
No. It is one thing for government to spend our money supporting unemployed Caymanians. Another to spend our money supporting employed foreign nationals many of whom do not have local health insurance as required by law and whose very presence in Cayman is therefore unlawful. Be there no doubt, where a Caymanian employer has not provided the health insurance, the full force of law should be coming down hard on the Caymanian. But is doesn’t, does it?
If they’re in Cayman they are to have health insurance by law. If the employer isn’t doing what they’re supposed to, how is that the permit holder’s fault?
If the permit holder comes here with insurance, then the employer cancels it or doesn’t pay the premium and the permit hold needs to make a claim only to find out that they don’t have coverage, it should absolutely 100% be the role of the government to remedy the situation.
The employer broke the law, so government should pay for the health care services rendered and then fine the employer to recoup the loss and fine them again for breaking the law.
If you put a few of these bad apple employers in jail once and a while for doing this it’ll put a stop to it real quick.
Maybe if their caymanian employers would pay their insurance fees and give them proper coverage this wouldn’t be a problem.
Maybe if the civil service enforced the laws and held the employers to account, it wouldn’t be a problem.
7.41pm Every time I visit HSA the waiting room is full of Jamaicans who don’t want to pay for any services. So W/P holders are a major part of the problem.
If the Hospital published a list of non paying patients going back to, say, 1990, everyone would be surprised at the huge unpaid bills of many prominent and/or very wealthy Caymanians. Many of these amounts were “excused” by the intervention of politicians but they were left on the books anyway.
6:01pm, you are correct, i find that to be true about the Jamaicans they are the worse here .
Certainly no risk of HSA ever competing with the private sector, that’s for sure.
We pay super high insurance costs and when it comes time to pay they only pay a fraction and thus people are left with sometimes large balances. If the hospital charges a certain amount and we pay the co-pay why is the insurance allowed to underpay. Why do hospitals and doctors charge more than what insurance will pay? Why are doctors allowed to charge up front? Time to revamp healthcare. In the meantime, the health minister is worried about masks! Chuh!
No kidding. My premium health plan didn’t even cover 80% of billed surgical anesthesia. I guess they thought I should be awake for part of it?
The rates agreed per procedure, that is covered by insurance, were fixed many, many years ago. Charges have gone up so we pay the ever increasing difference. And yet insurance companies put our premiums up by double digits. Why?
Appreciate this fact: The fees doctors are being paid by the insurance companies is the same fee they received 18-years ago. That’s right, doctors have not had a pay rise for two decades, while insurance premiums have risen by 400% during the same period. This is the reason why some (not all) doctors are charging a little above the “usual and customary” reimbursements by insurance companies.
It is the public’s money. The public is owed it! It is owed by hundreds of people, many of whom can pay. Many of whom are foreign nationals. Many of whom unlawfully have no health insurance. This is a brand of corruption and vote buying. If people cannot afford to pay, let them tell the judge. Our systems are just if you give them them a chance to work. Stop squandering the people’s money!
What can we learn from this… If the Law requires you to have insurance and you do not take out a policy the Public will pay for your medical care. The premiums you should have paid can be squandered on what ever you feel like, with no consequences. Instead of paying licensing fees I ignore them and CIG write them off and the fees I should have paid can be squandered on what I feel like and the Public don’t receive the revenue. So you are better off financially not obeying the Law it seems and let the Public pay your expenses.
Perhaps they’ll have to write-off that $1700+ they put on my bill for a procedure which was botched, for which they’ll never get paid!
CNS, the solar panels alone will not deliver that savings; however, the changing of the chiller systems, LED lighting replacement, and window replacement will combine to reduce energy costs by 20% per annum which is were the $360,000 comes from