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CINICO settles $1.5M hospital bills

| 29/01/2015 | 0 Comments

(CNS Business): Officials from the government’s health insurance company have confirmed that lawsuits filed against it in the US for not paying hospital bills of around US$1.5 million have all been settled. Lonny Tibbetts, the director of CINICO, said that both lawsuits filed in the Miami courts in November last year, relating to the treatment of ten Caymanian patients, were sorted shortly after they were served. The suits arose out of the failure of a third party administrator (TPA), contracted by CINICO to pay bills, to do so.

Tibbetts explained that one lawsuit was settled and a second withdrawn as the outstanding bills, which totalled around $1.5 million, related to a dispute between the Cayman Islands National Insurance Company (CINICO) and Simplifi that began in July 2013. Simplifi’s primary responsibility was to pay the claims but at the onset of the dispute it ceased all services, which, Tibbetts said, “significantly disrupted” the process.

“We in turn then had to first locate our claims, as Simplifi managed this entire process, and facilitate a local process of paying these claims in-house whilst simultaneously transitioning to our new TPA, which began services in January 2014,” Tibbetts explained.

Another challenge for CINICO was that providers and facilities have the ability to submit claims up to one year after the actual date of service and CINICO must research every claim it receives before it pays to make sure payments are not being duplicated.

“Between July 2013 and December 2014 we managed to pay the majority of our claims but unfortunately a number of claims fell through the cracks,” he said, explaining that these were the ones which had led to last year’s lawsuits.

He said the traditional protocol when a company changes a TPA is to transition services slowly and to synchronize claim history and eligibility but the sudden action by Simplifi left CINICO exposed.

Since then, however, efforts have been made to contact the major health providers and facilities that the company uses overseas to have them submit any further outstanding claims, and in the majority of cases it has worked out, Tibbetts said.

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Category: Insurance, Local Business

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