Telemedicine barriers increase burden on special needs community

    Billing and access questions continue

    Telemedicine billing and codes have been the subject of negotiations for many weeks.

    The disruption to daily routines caused by COVID-19 has taken a toll on all residents in the Cayman Islands, but for individuals with special needs, the crisis has been especially difficult.

    For those with neurological differences such as autism, scheduled times for school, work and therapy brought a necessary element of consistency to their daily lives. Access to therapeutic services plays an especially important role in maintaining quality of life for many people with specials needs, and the islands’ clinicians are fighting to maintain continuity of services.

    For medical-service providers and families, this has meant navigating uncharted territory with insurance companies and hurtling barriers to access regular appointments.

    Magda Embury, chairperson for the National Council for Persons with Disabilities, explained that the issue, in part, comes down to billing for telemedicine services. The council has contacted the Cayman Islands Health Insurance Commission, Embury said, to express concerns about billing codes established through 27 April that place certain limits on telemedicine appointments.

    “A good starting point would be that services/visits provided by telelink/videolink should be considered the same as in-person visits and paid at the same rate as regular in-person visits,” Embury said.

    “Our concern is that many persons with disabilities and their families are reliant on a daily basis on therapists and doctors to manage their conditions in a manner that is directly linked to the quality of their lives, and in many cases, to long-term goals for improvement or management of their conditions.”

    The council has advocated that therapeutic services continue throughout the shutdown through telemedicine, without limits being placed on the duration or quantity of sessions provided. Otherwise, many in Cayman’s special needs population risk regression on progress that may have taken years to achieve.

    Shannon Seymour, founding director of the Wellness Centre, compared the disruption in therapeutic services to suddenly losing access to medication for a chronic condition. The loss is immediately felt and can have severe consequences for the patient.

    “A lot of the parents are very, very worried, as are the clinicians very, very worried about what this means for this vulnerable population of persons with quite complex and significant impairment,” Seymour said.

    “They don’t have their school in the routine. They don’t have their activities and they don’t have their therapeutic interventions, as well.”

    For individuals with autism, for example, she fears that regression could result in self-injurious behaviours and deterioration of mental health.

    “The original code that [insurance providers] said they were going to cover was one 30-minute session per week. Well, some of our kids with severe autism are getting two hours a day of therapy,” she said.

    “One 30-minute session is not going to cut it.”

    Medical providers have been asked to present their clients’ situations on a case-by-case basis to insurance companies. As clinicians discuss their experiences, Seymour said they have found inconsistencies in what insurers communicate to different providers.

    Annikki Brown of the Cayman Islands Insurance Association said that presenting cases individually to insurance providers is not out of the norm, however.

    “This is not an unreasonable adjustment as the majority of insurers require treatment plans for these types of scenarios anyway,” Brown said.

    To address current needs, Brown said that approved health insurance carriers have made an allowance for telemedicine claims that was not previously possible.

    “There is no benefit for telemedicine in the Standard Health Insurance Contract. However, all insurers have agreed to cover basic telemedicine during this crisis,” she said.

    “A minimum coverage was agreed upon by all insurers and published [for] the providers. There are some insurers who may be able to make additional considerations. These would need to be requested from the insurer directly.”

    Mervyn Conolly of the Health Insurance Commission said Ministry of Health and commission representatives will be meeting with insurance companies and healthcare providers soon to discuss a way forward.

    Seymour is hopeful that through continued talks, the situation can be improved.

    “There’s been quite a bit of inconsistent communication from the various private providers,” she said, “but with a lot of perseverance and support from the Ministry of Health and our advocacy groups … most companies seem to be working with the private providers to try to find a reasonable common ground so that people can get services and the providers can get paid for them.”

    Seymour and Embury both want to ensure patients don’t end up with surprise bills or large co-pays that increase financial pressure on families.

    “Many persons with disabilities or their families pay a lot of money for their insurance and usually have upgraded plans specifically for coverage of specialised services,” Embury said, “so it is important for them to be covered and have insurance reimburse services accordingly.”

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