(CNS): Around 10% of healthcare providers are refusing to accept Cayman First Insurance cover at the point of need. Health facilities have been asking patients to pay upfront and claim back the money themselves because of significant delays in payments by the beleaguered local company, which has said it is working to persuade all providers to once again accept its clients’ cards, given the rollout of its new health portal. The Health Insurance Commission (HIC) has confirmed that Cayman First has met the conditions it imposed and is aware that this situation is “intolerable”.

Following a number of challenges at the insurance company relating to a shortage of staff, the departure of some senior and experienced employees, as well as difficulties with a new claims system, healthcare providers have experienced long delays in payment. While the HIC initially received just one official complaint, the regulator recently revealed that it has been working with CIF and had issued some conditions for it to maintain its Approved Insurer Certificate.

Superintendent of Health Insurance Mervyn Conolly told CNS that Cayman First provided the HIC with the required documents last week, as per those conditions, and more reports are due by the end of the month. He said that site visits would continue and other requirements would be made in relation to further reports.

Conolly also noted that it is unacceptable to the commission for insured persons to pay upfront for healthcare care benefits.

“While CFI will reimburse the insured persons for the ‘clean claims’, please be assured that CFI understands that going forward this is not tolerable,” he said. “For emergency services, all registered healthcare facilities would be expected to provide care. The Commission will hold the approved insurer accountable to address the access concerns with their customers and the registered healthcare facilities.”

Cayman First Managing Director Roger Balkissoon told CNS that he was confident that updates to the claims system and the additional functionality of the health portal would alleviate the “pain points” being experienced by providers.

“We acknowledge the impact this transition period has had on our members and their ability to access healthcare,” he said. “Over the coming weeks, we will be working directly with those providers who are not currently accepting Cayman First member ID cards – only about 10% of all providers on the island – to ensure their transition onto the new portal is quick and seamless, to allow our members to use their ID cards at these locations as soon as possible. All other providers accept our member cards without issue.”

He said that the insurance company remains in regular communication and good standing with the regulators, having met conditions set by the HIC and addressed their concerns around staffing and systems. 

“On 15 January 2023, we provided the HIC with our quarterly financial reports for the year 2022 and a view of our outstanding claims,” Balkissoon confirmed. “We will next be submitting an updated staffing plan, which includes a proposal to hire and train personnel dedicated to assisting those customers and claims that were impacted by the recent health system upgrade and hiring a consultant to help us create efficient workflows.”

Healthcare providers have access to the new health portal for client verification and more new functions will be rolling out this month, CIF confirmed in an additional statement. This portal allows providers to submit all claims online, allowing for quicker processing of payments to providers. Members will soon be able to access their invoices, claims and benefits information via that portal.

The company said the changes would ensure current and future claims are processed promptly and allow claims examiners to concentrate their efforts on working through the backlog as quickly and diligently as possible. 

“We understand the impact of the new system’s less-than-perfect implementation on our members, service providers, partners and employees, and we apologise for the inconveniences that caused while we worked to rectify the issues. We assure you that we are committed to our promise to protect you now and in the future,” CFI added.

Members who require urgent healthcare from providers not accepting cards are asked to contact a representative at the dedicated email address healthclaims@caymanfirst.com so that they can work with the client and the provider directly.