A new financial policy has been implemented by the Health Authority of Anguilla. It provides for persons seeking medical services to pay upfront if the fees amount to less than five hundred dollars rather than paying through an insurance card.
Chief Executive Officer of the Health Authority, Mrs. Maeza Demis-Adams, spoke to The Anguillian newspaper about the new arrangement. “Starting on Tuesday, January 8, we implemented a policy for the Finance Department and the Cashiers,” she explained. “It is that once a bill is under five hundred EC dollars, any client having Nagico Medical Insurance, will have to pay cash for the service rendered. The client will then take the receipt for that service to Nagico. The Insurance Company will then ensure that the client has met his or her deductible based on whatever policy that person has because different policies have different deductibles. Nagico will then reimburse the person based on the policy the person has.”
Questioned whether this would place the client or patient at a delayed disadvantage in terms of receiving the necessary insurance payment within a reasonable short time, the Health Authority’s CEO replied:
“It is actually the opposite situation,” Mrs. Demis-Adams remarked. “We normally do not get reimbursed from Nagico on an individual basis. Nagico would put a number of claims together and then reimburse us; but when you, as a client, go to Nagico, you are dealt with on a one to one whereas our claims are dealt with in bulk. I foresee no challenges with clients dealing directly with Nagico to get their reimbursements. Persons will be aware that sometime ago Nagico, under some policies, implemented the deductible. As I mentioned, different policies have different deductible rates and we have had, over the last eight or nine months, challenges with the deductible. That is because if persons come for services here and they have not met the deductible, the Health Authority is left with that bill. It is denied at Nagico because they haven’t met the deductible. It means that before an insured person can make a claim, he or she must meet the deductible.”
Asked what would be the position if the medical fee, payable by a person exceeds five hundred dollars, Mrs. Demis-Adams stated: “If it is more than five hundred dollars, you can then present your card and we will do the transaction on your behalf.
“We acknowledge that administratively we could not continue to manage deductibles in the way we were doing. We do not have the capacity to do so. That is why we decided to implement this new strategy.”
Ms. Patriesa Richard, the Chief Financial Officer, who is mainly responsible for financial matters, commented: “In the past we have been having some issues collecting deductibles. I assume that most people know that a deductible is something that has to be paid before you can claim your insurance. What has been happening here is that persons have been paying for services without paying the deductible. We would just put in the full claim and then we would be left with the burden of collecting the deductible.
“What we decided to do is to make it a sort of mandatory for persons to collect the deductible just like other healthcare facilities here in Anguilla. So we implemented a limit. That limit should cover their deductible. Again, for every fee under five hundred dollars, you have to pay upfront and then take your receipt, along with your claim form, to Nagico. Once you have money to be reimbursed, Nagico will reimburse that money to you.”
Mrs. Demis-Adams had the last comment: “The administration of this deductible has always been a concern for us at the Health Authority and I think for Nagico,” she added.
The matter has resulted in much discussion across the island and on social media.
