Insurance company battles to regain trust of providers

| 25/01/2023 | 40 Comments
Cayman First Insurance, Cayman News Service
CFI MD Roger Balkissoon

(CNS): Around 10% of healthcare providers are refusing to accept Cayman First Insurance cover at the point of need. Health facilities have been asking patients to pay upfront and claim back the money themselves because of significant delays in payments by the beleaguered local company, which has said it is working to persuade all providers to once again accept its clients’ cards, given the rollout of its new health portal. The Health Insurance Commission (HIC) has confirmed that Cayman First has met the conditions it imposed and is aware that this situation is “intolerable”.

Following a number of challenges at the insurance company relating to a shortage of staff, the departure of some senior and experienced employees, as well as difficulties with a new claims system, healthcare providers have experienced long delays in payment. While the HIC initially received just one official complaint, the regulator recently revealed that it has been working with CIF and had issued some conditions for it to maintain its Approved Insurer Certificate.

Superintendent of Health Insurance Mervyn Conolly told CNS that Cayman First provided the HIC with the required documents last week, as per those conditions, and more reports are due by the end of the month. He said that site visits would continue and other requirements would be made in relation to further reports.

Conolly also noted that it is unacceptable to the commission for insured persons to pay upfront for healthcare care benefits.

“While CFI will reimburse the insured persons for the ‘clean claims’, please be assured that CFI understands that going forward this is not tolerable,” he said. “For emergency services, all registered healthcare facilities would be expected to provide care. The Commission will hold the approved insurer accountable to address the access concerns with their customers and the registered healthcare facilities.”

Cayman First Managing Director Roger Balkissoon told CNS that he was confident that updates to the claims system and the additional functionality of the health portal would alleviate the “pain points” being experienced by providers.

“We acknowledge the impact this transition period has had on our members and their ability to access healthcare,” he said. “Over the coming weeks, we will be working directly with those providers who are not currently accepting Cayman First member ID cards – only about 10% of all providers on the island – to ensure their transition onto the new portal is quick and seamless, to allow our members to use their ID cards at these locations as soon as possible. All other providers accept our member cards without issue.”

He said that the insurance company remains in regular communication and good standing with the regulators, having met conditions set by the HIC and addressed their concerns around staffing and systems. 

“On 15 January 2023, we provided the HIC with our quarterly financial reports for the year 2022 and a view of our outstanding claims,” Balkissoon confirmed. “We will next be submitting an updated staffing plan, which includes a proposal to hire and train personnel dedicated to assisting those customers and claims that were impacted by the recent health system upgrade and hiring a consultant to help us create efficient workflows.”

Healthcare providers have access to the new health portal for client verification and more new functions will be rolling out this month, CIF confirmed in an additional statement. This portal allows providers to submit all claims online, allowing for quicker processing of payments to providers. Members will soon be able to access their invoices, claims and benefits information via that portal.

The company said the changes would ensure current and future claims are processed promptly and allow claims examiners to concentrate their efforts on working through the backlog as quickly and diligently as possible. 

“We understand the impact of the new system’s less-than-perfect implementation on our members, service providers, partners and employees, and we apologise for the inconveniences that caused while we worked to rectify the issues. We assure you that we are committed to our promise to protect you now and in the future,” CFI added.

Members who require urgent healthcare from providers not accepting cards are asked to contact a representative at the dedicated email address healthclaims@caymanfirst.com so that they can work with the client and the provider directly.


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Category: Health, Health Insurance

Comments (40)

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  1. confused says:

    You can’t blame the 10%. They aren’t getting paid. How do they run their business if the submitted claims go unpaid? Free service sounds great until the physicians goes out of business and no service is left to be had.

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  2. Anonymous says:

    I just had a $2000 bill from a care provider, literally today, after CFI preapproved a treatment, I paid my deductible, but then CFI only paid up 400. now the provider wants the difference from me.

    absolute nightmare

    24
    • Anonymous says:

      You obviously did not check with the insurance company before the treatment that they would reimburse for the care, and ask them to confirm that in writing?

  3. Anonymous says:

    Ditched them and moved to another firm.

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  4. Anonymous says:

    This is what happens when you sell-out to foreign. The longstanding employees and institutional know-how were dismissed for cheaper labour. The decision makers in Bahamas lack the touch points on the ground to realise their decision to cut staff was a bad idea…

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    • Anonymous says:

      Anything that Bahemians touch here in Cayman, turns into SH-T

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    • Anonymous says:

      The new Bahamian owners made the local experienced staff turn off the claims system that worked well and bring in a new system by the foreigners.

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  5. Anonymous says:

    I’m more worried about the increase in daily ambulance and police sirens, where i live at least 5 times every single day in the last few months, and sometimes the ambulances are are wizzing by without sirens….what is going on?

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  6. Anonymous says:

    CFI is a complete and unmitigated disaster

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  7. Anonymous says:

    1. Who is responsible for the new systems less-than-perfect implementation?
    2. Who is responsible for the poor planning and other senior leadership shortcomings that has resulted in a shortage of staff?
    3. Why have so many senior and experienced employees left the company?

    It would seem to me that Cayman First Managing Director Roger Balkissoon has dropped the ball and needs to be held accountable for the issues facing the company and for the damage that has been done to the companies reputation.

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    • Anonymous says:

      Roger is just a puppet for the Bahamas management. Not surprisingly all talented personnel left because they didn’t want to be there unable to service the Caymanian members knowing bad decisions were being made by a Bahamas team that has never been in the health insurance business before!

  8. Anonymous says:

    So Mervyn, so tell us what you are doing about the double dipping providers who charge their patients then wait a few months and bill the insurance companies for same.

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    • Anonymous says:

      This would be criminal fraud and would land a doctor with a very large jail sentence. Extraordinary (in this case, outrageous) claims require extraordinary evidence, evidence that should be presented to the Health Practice Board and to the fraud division of the CIPS. Otherwise, don’t be a troll and a trouble-maker.

  9. Anonymous says:

    I got 2 things to say here one being that Roger looks strikingly similar to Enrique Iglesias! Seriously I just went from 6 to midnight. Da other is in order for dees health companies to run well it needs to be managed by hard working Caymanians on all levels to provide best of care for the community.

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  10. Anonymous says:

    The whole medical system is in need of reform. Start by treating the cause and not the symptom. Our insurance should cover more alternative treatments that do just this such as chiropractic, acupuncture, homeopaths, naturopaths and nutritionists. Also, the COVID jab mandate needs to be FLUSHED post haste.

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    • Anonymous says:

      yeah, let’s do away with the MMR and the polio vaccine too! down with health!

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      • Anonymous says:

        Because administering the two year old jabs for a virus that no longer genetically exists is logically the same as giving a polio vaccine that actually prevents polio.

        The magnitude of stupidity is astonishing. And the medical industry says nothing. Good job doctors!

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    • Anonymous says:

      you think a nutritionist is some kind of crazy alternative treatment? lolz

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  11. Anonymous says:

    I hate Cayman First with a passion. My car insurance renewal came up and when I tried to switch, they refused to issue me a letter honouring my no claims discount…. so I had to reluctantly stay with them just to be insured. I will be moving as soon as I can!

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    • Anonymous says:

      Staying with them, held hostage, is your [Cayman] First mistake.
      You should have just ditched them on renewal & gone to another reputable firm. The no claims is not worth it.
      Just wait and see what happens, if you have to make a vehicle claim.

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  12. Anonymous says:

    Such opticians should have their licenses cancelled

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  13. Anonymous says:

    It is illegal for medical providers to refuse to accept a CIMA licensed and Health Services Commission approved insurance card.

    Why is CIG silent about his breach of Cayman law by the 10% mentioned in this article.

    Mr Connolly and his team are well aware of this. As usual selective enforcement of laws.

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    • Nautical-one345 says:

      Your last sentence – there-in lies the problem with so much that is wrong in our Cayman Islands.
      A land of many, many laws….enforcement – not so much!

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    • Anonymous says:

      it is also illegal for the insurance company to be in breach of payment. why should the cost of the service fall onto the provider? I feel for those that have to pay upfront(i had to and was not happy) but its a service that has to be paid for. if insurance company fails to pay, then change your insurance company… dont blame the provider of service

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      • Anonymous says:

        One of the most rotten things we have imported from the US partially unwittingly is the idea that health care should be a for profit service where the payment serves as a barrier for care

        Medical care aside from cosmetic and optional procedures should be free at the point of service and we should have a single national insurer that covers Caymanians, with the ability for expats to buy in for a higher cost

        In the near future we will look back on for profit health care and health insurance as the barbaric and unethical practices that they are

    • Anonymous says:

      And, there are doctors/providers that NEVER accept approved medical insurance for patients. Their patients must pay up front and then submit their own claims. Why has the insurance commission not fined these practices for doing this? It has been going on for years and years. Will the Powers That Be please DO something about this PLEASE!

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  14. Anonymous says:

    Cayman First…. I terrible service and rude. I will never use them again. Sent they owned by a company from the Bahamas?

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  15. Anonymous says:

    Ever since local companies have divested majority ownership or local HQ to other Caribbean companies based elsewhere, the standards of their customer service and other services have declined. Overseas management do not make Cayman customers a priority.

    FLOW (SLOW) the very worst/ CIBC (First Caribbean) / ScotiaBank /even CNB!!

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  16. Anonymous says:

    It’s truly abnormal that these assurances are being offered to the over-billing providers expecting cash cover, and not the premium-paying employers and their members expecting a health insurance service. Who is the client again?!? Cayman has it all backwards. Nice of them to air their internal dysfunction so that we can avoid them.

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  17. Anonymous says:

    Conolly also noted that it is unacceptable to the commission for insured persons to pay upfront for healthcare care benefits.

    Tell that to the opticians.

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