A second round of legal manoeuvres is expected today when the Health Services Administration fires another salvo of summonses against insurance companies.
At issue is almost $4 million in insurance claims HSA says it is owed.
‘The question with insurance companies is one that has been going on for a very long time,’ said Health Minister Gilbert McLean.
Mr. McLean said HSA is suffering because they payments are not being made. He was able to secure $10 million from Government to help HSA, but depending on Government for funding is not the way to go.
‘I am distressed that people faithfully pay their premiums each week or each month and when they proffer the card, expect their care to be paid for. That is certainly not happening in HSA.’
Keith Myers, legal counsel for HSA, said the insurance companies aren’t paying the bills, claiming that HSA filed the claims after 180 days. Insurance claims must be filed within 180 days or, by law, the insurance companies don’t have to pay.
Mr. Myers contends the insurance companies aren’t complying with the Insurance Law.
‘We file a claim and never hear anything from them,’ he said. ‘We have no idea if the claim is going to be paid or rejected.’
He admits that a few claims may have been filed late because of system problems, but that the majority of them were filed in a timely fashion.
‘Even if we made mistakes at registration, they wouldn’t total anywhere near $4 million,’ he said.
Mr. McLean said HSA now has a proper accounting system in place and enough staff to handle insurance claims.
All insurance companies that owe HSA have been sent standard demand letters along with balance sheets that detail the patients’ names, dates of service and amounts billed.
‘It is a corporate entity. It has the right to collect. In my opinion it was the correct thing to go to the courts,’ Mr. McLean said. ‘I as minister would like to know that we don’t have to turn to litigation, but at this stage it is becoming obvious that they are not paying, particularly when HSA is doing all the right things.’
Mr. Myers said the Cayman Islands Monetary Authority and the Insurance Commission have been kept abreast of the problems between HSA and the insurance companies.
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