The Cayman Islands government has gone silent regarding how an abrupt decision to switch providers involved in the processing of most healthcare services claims made via government-issued CarePay insurance cards was reached last week.
Effective Wednesday, Oct. 1, the Cayman Islands National Insurance Company has switched providers involved in the processing of about 90 percent of the healthcare services claims from its contract with Advanced Information Systems Cayman Ltd. and St. Lucia-based Health Adjudication Systems, to a Detroit-based company, Automated Benefit Services.
The change led to allegations by the current healthcare claims system provider that the government had breached its contract with the company.
Finance Minister Marco Archer, who has oversight responsibility for the Cayman Islands National Insurance Company or CINICO, has indicated he cannot respond to Cayman Compass questions about how the change was contractually managed by government. Health Adjudication Systems has a current contract with government through December 2015.
“Given the nature of the matter, we have no comment,” Mr. Archer said.
CINICO chief executive Lonny Tibbetts released a statement on the matter last week. He explained the process of handling healthcare claims going forward, but did not state why government had made the change with a current contract in place.
“The current change of claims processing at the Cayman Islands Health Services Authority for CINICO members will have little to no effect on our Members’ interaction,” Mr. Tibbetts said.
“All civil servants and pensioners, seafarers, veterans and indigent members will still require their CarePay card for verification of coverage. The only change in these members’ interaction will occur in the printing of an adjudicated receipt [for healthcare coverage], which will no longer occur at each interaction but will be presented to our members via our new online member portal.
“The other change that will occur will be in the administration of these member claims. The Health Services Authority will now be submitting these claims to our new third party claims administrator [Automated Benefit Services].
“As for our other members who subscribe to either of our Standard Health Insurance Contract plans, affordable members or silver members will experience no change in their interaction. As before, they must present their CarePay cards for both eligibility verification and claims processing. They will also continue to receive an adjudicated claim receipt at each interaction to identify CINICO’s financial responsibility for the cost of that interaction as well as what they will have to pay the Health Services Authority.”
The CarePay cards, introduced by the Health Services Authority in 2011-2012, were put in place to provide “real-time” healthcare claim adjudications, giving the Cayman Islands hospital system more accurate records of patient payments with an eye toward reducing unpaid bills.
In recent months, government leaders questioned both the cost and effectiveness of the system, which has never been fully implemented as intended according to its original contract to include private sector health insurance providers.
The chief executive of Advanced Information Systems, Jamaica, Douglas Halsall said it was his view that the Cayman Islands government was currently in breach of its five-year contract with AIS’s sister company, Health Adjudication Systems, which extends through December 2015.