Matters in Healthcare: The hot topic - Upfront payments for care providers' services

FRIDAY, NOVEMBER 4: The BHeC (Bermuda Health Council) and the Bermuda Sun have teamed up to answer your questions about the island’s healthcare system.

Visit www.bhec.bm to submit your queries and look for our response in each Friday’s Bermuda Sun and on bermudasun.bm.

This week’s question focuses on upfront fees for medical treatment.

Question: I went to the dentist earlier this year, as I do every six months, and for the first time I had to pay for the treatment upfront.

I have the same insurance company that I have always had, so I was surprised by this change in payment structure.

The dentist’s accountant helpfully explained that she would give me the receipt and all of the documentation to take to my insurance company so I could be reimbursed.

The treatment was almost $200, which is expensive for me, especially after it was on top of my monthly contributions to health insurance, which are almost $300.

I was eventually reimbursed (almost a month later), but the initial out-of-pocket expense was shocking and made me rethink visiting the dentist.

I know others who have also encountered their doctors asking for payment upfront! I think it is incredibly unfair and talk about expensive healthcare.

What is being done to change doctors and dentists asking for payment upfront?

Answer: Thank you for your question. The Bermuda Health Council (BHeC) was first asked by the Ministry of Health to investigate upfront payments in 2008.

Three years have passed and after many reviews, consultations, best practice guidelines, and improved reimbursement, the practice continues as you, the questioner, have noticed.

The issue is complex, and is complicated further by the validity of all stakeholders’ positions.

Charging insured patients 100 per cent at the time of service is seen as necessary by some healthcare providers to avoid cash flow problems caused by delays in insurance reimbursement.

But insurers vary in their ability to reimburse promptly, particularly where claims are submitted with incomplete or inaccurate information.

And patients, the ones most affected by upfront payments, are left no option but to vote with their feet.

Physicians know this. When a visit requires paying upfront, cash‐conscious patients just don’t go. Problems escalate and costs follow.

There’s no easy solution, but the Ministry of Health has asked the BHeC for assistance in securing a resolution.

Nothing will make everyone happy. But all stakeholders are united in their primary concern for patients’ best interest.