Insurance firm blocks cover at Health City

| 06/04/2017 | 38 Comments
CNS Business

Health City Cayman Islands

(CNS Business): British Caymanian Insurance Company (BritCay) will not cover patients to attend Health City Cayman Island for any treatment unrelated to cardiac care. In a memo sent to people who are insured by the agent that represents Colonial Medical Insurance, the firm said it wanted to review all the services that the hospital now provides and check prices before it will cover patients to be treated for anything unrelated to pre-authorised heart treatment. Health City, which was not warned about the decision, said it was concerned that issues “other than patient welfare” were behind the decision, leading to negative impacts on patients.

In the correspondence to its clients, many of whom do not have a choice in their insurance cover as it is part of a group employment plan, BritCay said it must “ensure that all services provided at the Health City Cayman Islands facility are compliant with our contractual requirements”.

Undermining one of the purposes of the government’s partnership with the specialist tertiary care hospital to reduce the need for people to go overseas for treatment, BritCay also encouraged its clients to do just that.

“When certain services are not available locally, you, our member, can access one of the most comprehensive provider networks in the US. The network utilised is a premier, accredited US national preferred provider organisation (PPO) network with over 723,000 participating physicians and 6,400 hospitals,” the insurance firm stated, adding that it would “take us some time” to deal with the clearance for treatment at the East End hospital founded by Dr Devi Shetty.

“Any services outside of cardiac-related procedures will not be eligible for benefits, unless it is deemed emergent and pre-certification/authorization has been obtained,” the insurance firm said, adding that only scheduled pre-certified procedures organised before 1 April would be covered at Health City.

Surprised by the insurance firm’s decision, Health City said the decision by BritCay to limit services was made unilaterally by the company and the hospital was not informed before the notice was sent to its customers.

“Unfortunately, this raised questions in some patients’ minds regarding the standards and quality of service at Health City Cayman Islands,” said Dr Chandy Abraham, CEO & Director of Medical Services, at the hospital.

The doctor said that Health City provided service of the highest standard to all patients.

“We are the only medical facility in the Cayman Islands that has third-party verification of our quality in the form of our accreditation by the Joint Commission International (JCI). The high standards of our service can be clearly seen by the successful outcomes achieved as well as the affinity our patients hold for Health City,” he added.

Dr Abraham said the facility was fully compliant with every government-imposed regulation, evidenced by the Health Practice Commission (HPC) accreditation of it services.

“Our first concern with regard to the announcement by BritCay has been the health and safety of our patients,” he said. “The policy decision by BritCay appears, in our opinion, to be driven by considerations other than patient welfare and could have a negative impact on patients with regard to convenience, ancillary expenses, and the safety of their health.”

He said that HCCI is in contact with BritCay and he was hoping for “above board and transparent negotiations” ahead.

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Category: Healthcare, Insurance, Local Business

Comments (38)

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  1. Archie says:

    There are always two sides to any story. If the insurance company has taken steps like this, I am sure they have a reason. it is shame this story has not quoted them.

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    • Anonymous says:

      A reason indeed...protecting their mates...against the cheaper upstart with a great record of getting things done properly...and an international group at that.

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  2. Anonymous says:

    Local intrigues at play. Why on earth would they not use an excellent facility with good care standards that is a lot cheaper than the other options? You wait, they will be trying to increase our premiums next, citing increased costs. As long as health city has its license it should be acceptable. End of story.

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  3. Sharkey says:

    Read Garfield Weston comment, and the Insurance company article , and the Dr article that wants to have his own candidates elected this election, and you should be able to see the big political picture of what will be coming in the very near future .

    I think that we should be listening to and watching the candidates before the Election the closest we have ever before you cast your vote . Because I think that now we don't have a Government that is looking / working for the people . If we don't stand up, we won't be seen .

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  4. Anonymous says:

    Health Insurance companies working in Cayman are rip off. It is about time we hold these companies accountable.

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    • Tell de Truth says:

      This is a pile of crock crap Brit Cay. Your Government approved license does not grant you the right to discriminate services. The new Government will take care of your pandering to overseas facilities. I would if I had the power cancel your licence until this matter is cleared up. Crock crap Brit cay and it smells..

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    • Sharkey says:

      I think that it's not the Insurance companies that we need to hold accountable , it's those politicians that see the same thing , and says the same thing you are saying about the Insurance companies to get elected , then when he/she gets elected they do the opposite . They need to be told that we would be holding them accountable before they are elected and after .

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  5. Anonymous says:

    Just another Bermuda based company decision, Bermuda's economy has been in the crapper for years, the companies operating in Cayman and headquartered there are getting squeezed to the detriment of the Cayman customer. Noticed any increased fees, or reduced service? Cayman gets to pay for Bermuda's largess and inability to balance a budget.

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    • Anonymous says:

      I am yet to come accross a Bermuda centered organization that has due regard for the Cayman Islands or their people, whether our rules expect or require it, or otherwise.

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    • Anonymous says:

      Butterfield bank is a prime example of that.

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  6. Anonymous says:

    I can buy better and cheaper insurance in the US that will cover me at Health City (and anywhere else I need it). It is time we demand our government free us from the grip of these local players who are seemingly abusing their privilege.

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  7. Sharkey says:

    My beef with this issue is , where is the Government representation of the people / consumers , that the Insurance company can operate in the Cayman Islands , and say what they would have in their policy , and which Hospital they would cover , and what procedure they cover , pretty soon they would be telling you which medications that they will cover . If we don't change
    the whole of Government this election , worse will come .

    I think that this is very much in your face , what the Government is doing and alowed to happen in the Cayman Islands, all because of greed and corruption .
    The Insurance companies really have you because of the size population, but better can be done if Government worked on the issue for everyone's benefits .

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  8. Anonymous says:

    What a criminal company! Why can't we regulate these insurance companies??!

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  9. Anonymous says:

    Insurance companies have only one goal. Make profit for the shareholders.
    I am waiting for approval by my insurer for an urgent mri. I can not work from the pain. I am waiting about a week now.

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  10. Anonymous says:

    This is an outrage and unless BritCay resolves this situation quickly, our company will look for other insurance coverage immediately

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  11. Anonymous says:

    Who are the Big Boys in BritCay? Something fishy here. This does not pass the smell test.

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    • Anonymous says:

      BritCay is just a puppet, a mouthpiece for Colonial in Bermuda. Their role is principally administrative. All the strategic/policy decisions are made in Bermuda.

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      • Tell d Truth says:

        Colonial and some big local shareholders?

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        • Anonymous says:

          Local shareholders were not informed and are among those threatening to move their business, This was a Bermuda decision.

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  12. Anonymous says:

    More to this than meets the eye, that's for sure. I personally was shocked when I read the letter sent to me, especially the going overseas encouragement.

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  13. SKEPTICAL says:

    This has the stink of "Politics". Why has BritCay/Colonial (In Bermuda) suddenly made this decision, when clearly they have until now been covering non- cardiac procedures at the Shetty Hospital. Have they suddenly discovered a serious issue with the professional standards at the hospital - and, if so, why have they not made that information available to the public, Or, at least Government.
    Hopefully, their current major customers will vote with their feet, and move their business elsewhere. Because we know Government is not going to do anything to determine why BritCay/Colonial made this decision.

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    • Dr. Jeckyl says:

      The insurance companies aren't worried about the service. They are worried about their payout!

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  14. Anonymous says:

    I'm so happy to be a civil servant. Anyone wants to trade up? We have a few fantastic jobs available. www.gov.ky.

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    • Anonymous says:

      How does your Cinico work out for you at Health City?

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    • Anon says:

      Your time is coming. Free healthcare for you no more.

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  15. Anonymous says:

    If you're an employee on a BritCay group plan and are not happy with this, be sure to tell your employer. It's not that hard to change provider come renewal time

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  16. Anonymous says:

    Health care should be a human right. Not a privilege of people with money.with money. Now the health care system exists to make money for the insurance companies, not for the well being of the people.

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  17. Anonymous says:

    Colonial has to meet their guaranteed number of patients to their network in order to get the big network discounts. They are not worried about the inconvenience and added expense to the patients and their families. When care is available on the island the patient should have the choice of getting that care locally. The insurance companies pay according to the standard fees so the charges at HC are irrelevant to this action by Colonial. There is something else behind this.

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    • Bang on 8:20. They are called local doctors and local doctors know how to exert pressure on key pressure points.

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    • Anonymous says:

      I have always been baffled by my BritCay insurance because when I go overseas for treatment they cover 100% of the cost but when I go to Health City they will only cover 80% even though the same treatment is about 40% cheaper at Health City. This was an encouragement for me to go overseas until Health City started to waive my 20% copay. I have been made to understand that Britcay is now requiring Health City to charge the copay on all hospital visits from BritCay customers, if this is so I will be moving definitely.

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  18. Anonymous says:

    I hope the new government will tackle the insurance cartels! They rip us off every month and when we eventually do need treatment they break it off in us again with the co-pay.

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    • Anonymous says:

      Agreed! Insurance companies need to make a profit, but we also shouldn't be penalised for using our insurance when we fall ill.

      Government intervention needs to take place.

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    • Might have more to do with the local doctor cartel rather than the insurance cartel. Can't be a cartel when Britcay has 80% of the market. More like a monopoly. Health City doctors are cutting into the big money local doctors are making. Everybody I know has been very impressed with Health City health care and enjoy not having to go to the expense of going to Miami.

      Take a look at who is financing candidates from a medical background in Cayman.
      Think about it.

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  19. Anonymous says:

    Would be so sweet it Health City refused to accept BritCay insured cardiac patients. However, I doubt Health City would stoop to BritCay's grossly sub-par standards.

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    • Rob says:

      Don't say that. If people die because of a petty tit-for-tat, that would not be sweet.

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  20. Anonymous says:

    Where the hell are our so called health insurance regulators on this?

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    • Anonymous says:

      Likely at an industry conference in Iceland, of The Seychelles. More likely on the phone trying to hire an consultant to tell them what to think.

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    • Anonymous says:

      We are compelled to have super expensive coverage and then they tell us that we cannot use it at home at government approved facilities, and instead must do it elsewhere, even if it is at greater expense? It seems we have no effective regulators. Just another cartel!

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