New payment system in place

The Health Services Authority this year introduced a new billing and insurance adjudication system which will help eliminate bad debts incurred through insurance denials and patients failing to pay.

The card-swipe system, know as Real Time Adjudication, has initially been made available only to CINICO customers through their CarePay cards, but the HSA plans to roll it out to clients of private insurance companies in due course.

Chairman of the Health Services Authority Canover Watson has described the new system as a “revolutionary step” for the HSA, adding that about one quarter of all overhead costs in healthcare are due to problems with the billing system.

He said the CarePay and Real Time Adjudication system would result in major cost savings, which could amount to up to $40 million during the next 10 years.

The initial phase of the system costs US$1.3 million, which was paid for by CINICO and the HSA. The government intends to put another US$2 million into the system to develop it throughout the Cayman Islands for use by insurers and medical practitioners in the private sector, Mr. Watson said.

Speaking at a media briefing to launch the system in May, Minister of Health Mark Scotland told reporters: “I am extremely pleased that we have reached this milestone of implementation of this system, and although we have started within the Health Services Authority and CINICO, the ultimate goal is to include all commercial health insurance companies, thereby reducing their administrative overheads, improving coordination of benefits between insurance companies and greatly increasing patient and physician billing convenience, while modernising the entire system for all residents of the Cayman Islands to benefit from.”

The system was launched at the Cayman Islands Hospital on 1 May.

Since October 2011, CINICO has been issuing its 13,000 customers with CarePay cards. Each member is required to bring them with the card, and a form of identification, to the hospital or health clinic. Once a CINICO patient’s card is swiped, the hospital has immediate access to information about the patient’s eligibility and payment.

The aim of the system is to take the guess work out of whether a person is eligible for treatment and will immediately outline how much of the cost of treatments the insurance company will cover. It will also help prevent outstanding debts.

Another benefit of the new system is it helps prevent misuse of the system, as there have been occasions when CINICO members have given their old cards to others to receive free treatment. It also prevents former government employees or those who are no longer covered by CINICO from using old cards.

CINICO insures civil servants, pensioners, seafarers and indigents.

The CarePay card can be used for any medical or dental service with a chief medical officer or chief dental officer pre-authorised referral.