(CMR) Amid concerns raised in the community about Cayman First Insurance, the Health Insurance Commission (HIC) said it is monitoring the situation at the health insurance company.
In a release issued Wednesday, HIC said in late September/ early October 2022, it received an informal verbal complaint from a registered healthcare provider about Cayman First Insurance (CFI). This was the catalyst for a fact-finding mission that, based on its outcome, triggered an investigation by the HIC, working in consultation with the Cayman Islands Monetary Authority (CIMA).
The HIC found there was a shortage of personnel at CFI and that there were problems with a newly introduced claims filing system which impacted clients being able to access the insurer. It also impacted registered healthcare providers being able to file claims directly, thus impacting their ability to receive payment for their “clean claims” in a timely manner.
The HIC has since been in regular contact with CFI senior leadership- President and Vice President- via weekly phone calls, regular exchange of emails, and frequent updates. The HIC also conducted a site visit of the CFI’s office.
CFI senior leadership has assured the HIC that these issues are being addressed but that they will require some time for the complete resolution of the challenges.
CFI said it issued a release to a local media house to update stakeholders on the situation in November 2022.
Even though the HIC recognizes the efforts which CFI has made in working to rectify the situation, the HIC has, nonetheless, imposed a series of conditions on CFI with which the insurer must comply to maintain its Approved Insurer Certificate. These conditions include, but are not limited, to the following submissions:
1- Quarterly financial reports for the year 2022;
2- A written mitigation plan for the system integration and restoring appropriate staffing levels;
3- Monthly reports for:
- Outstanding historical claims (ie: claims over 30 days)
- Current outstanding claims
4- A timeline for the resolution and clearance of identified backlog (claims payments and enrollment);
5- Providing the HIC with a complaints-handling policy.
CFI is expected to provide an update to the HIC on the staffing and systems issue by 15 January 2023. However, the HIC will also be pursuing the insurer to provide stakeholders with more regular updates on adherence to the conditions and ongoing steps to resolve the above-stated issues as a matter of public interest.
Despite numerous complaints online, the HIC said, to date, it has only received the one initial informal verbal complaint from a registered healthcare provider. However, the Commission is aware that statements have been made in the public domain that there potentially is a number of other providers who have been impacted by the issues relating to the non-payment of claims.
The Health Insurance Regulations (2017 Revision) states in sections 9 (6) and (7) that: (6) where an approved insurer fails to pay a claim in accordance with the time limit set out in sub-regulation (1) and there is no dispute as to that claim, the approved insurer shall be liable to pay interest on the money owed from the thirty-first day after the claim has been submitted to the date on which payment is made to the health care facility or registered medical practitioner.
(7) The rate at which interest is payable under subregulation (6) is at the rate of two percent above US prime interest rate in force from time to time.
Registered health care providers, as well as clients who have been impacted by the non-payment of claims or any other concerns, are encouraged to file a formal complaint or contact the Health Insurance Commission by email on [email protected] or by phone on 946- 2084. The HIC office is located at the Government Administration Building.