Lack of insurance payments jeopardises neurosurgery

Two neurosurgeons who service the
Cayman Islands say that unless insurance companies pay to cover patients to be
operated on locally, the availability of brain and spine surgeries in Cayman
could be in jeopardy.

Doctors James Akinwunmi and Peter
Kowlessar, who work with Chrissie Tomlinson Memorial Hospital and the George
Town Hospital, said that while they are keen to continue to offer neurosurgery
in Cayman, they need to be paid so they can continue to reinvest in equipment
to continue to carry out operations and services locally.

Both surgeons have been visiting
Cayman once a month for a week over the past 18 months to work with patients. Their
visits make neurological services, which include brain and spinal surgeries and
treatments, available on Island.

Speaking at a meeting last week at
which they outlined their work in Cayman and the challenges they face, the doctors
said they have had problems getting paid.

“One of the big problems we have
is… payment. It’s the same for the hospitals. This is quite crucial. We are
not profit-making, but we need to make some profit to reinvest into the
service. If we do not get paid, that’s a problem,” Dr. Akinwunmi said.

He added: “We want to bring the
service here. We want to keep the revenue on the island. We want to expand. We
want to look forward…  We are keen to
make sure this service survives,” he said. “It will not survive if we are not
paid. It will not survive if it is not used. We are Cayman Islands’
neurosurgeons, not just the HSA’s or Chrissie Tomlinson’s.”

According to the government
insurance company CINICO’s most recent annual report, in the 2007/2008
financial year, the government paid nearly $1.7 million for neurologic care
overseas and more than $1.3 million in the last financial year.

Dr. Akinwunmi said that when he
first looked at setting up neurology services in Cayman in 2007, he had been
told that between $4 million and $6.5 million a year was being spent on
neurological care for residents of Cayman overseas. “That money is not coming
back,” he said.

Asked by a member of the insurance
industry attending the meeting what insurance companies need to do, Dr.
Kowlessar responded that the health insurers should spread the word to their
colleagues that neurological services are available in Cayman.

 

Remuneration a problem

“[Spread] the word to others in the
insurance industry that it can be done here and can be done here safely,” Dr.
Kowlessar said, adding: “The whole problem really is the remuneration, being
paid for the service. It’s as simple as that.”

Dr. Akinwunmi said the surgeons
were not being paid for prosthetic fees, for example. “We put prosthesis in as
standard practice all around the western world, and we are not being paid for
that. That, in effect, is something we have to pay or there is a gross delay on
that, and in all honesty, that is what is killing the service.”

He said in some cases, insurance
companies were pre-authorising fees, but then not paying up.

Health Minister Mark Scotland, in
his opening comments at the meeting, said collaboration between the public and
private sectors, as well as the insurance industry, is necessary for specialist
care, such as neurosurgery, to exist in Cayman.

“Medical professionals do not
function in a vacuum and they need their colleagues’ support, as well as the
goodwill of health insurance providers if they are to close the local gaps in
specialist care availability,” he said. “While the government should indeed
take the lead in shaping a favourable health-care environment via our policies
and legislative framework, the private sector must also strive to engage in
each other’s efforts. For me, the answer undoubtedly lies in a collaborative
approach.

“Neurosurgery is a highly
specialised field, and having access to neurosurgery practices and other
specialities here on Island are a significant step for all of us, one which we
should all be thankful for,” Mr. Scotland said at the meeting, which was
attended by many of the Islands’ medical professionals, insurance company
representatives, lawyers and officials from the Health Services Authority and
Chrissie Tomlinson Hospital.

Dr. Akinwunmi, who is based in the
UK, and Dr. Kowlessar, who practises in Trinidad, said that when they are not
on Island, they can read patients’ scans that are sent electronically and can
make recommendations on whether those patients could wait for surgery or
treatment until their return to Cayman or need to be flown off Island for
immediate care.

Chief Executive Officer of the
Health Services Authority Lizzette Yearwood thanked both doctors for “saving
many of our patients’ lives”. She reiterated that the hospital, like the
neurosurgeons, has problems getting payouts for medical procedures, due to
verification issues, delays in payments and the lengthy time it can take to
adjudicate claims.

“A lot of our problems stem from
eligibility. The insurance companies do a great job, but unfortunately, there
are those times where we have pre-authorisation and then later on down the line
we find out that, by the way, the coverage has already been maximised and
‘sorry, we’re not going to be out of pocket’,” she said.

The government has commissioned a
team to look into eligibility verification and billing, and a request for
proposals has been issued for a company to undertake that work.

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