Fees & Insurance
My Rates are AVERAGE!
It’s a common misperception that most doctors set their own inflated rates and vary them for all sorts of reasons. In Cayman, the insurance companies set a ‘standard’ reimbursement rate for different types or episodes of care or procedure. Those rates are adjusted (by the insurance companies) depending on the nature/complexity of the consultation and occasionally by time of day for more emergency-type care. The greatest challenge doctors face is that the Standard Fee Schedule has not been changed since 2005 but healthcare and costs have. For instance, in paediatrics, the standard reimbursement for a Pneumococcal vaccine visit is $43.36 CI but the cost of the drug alone for this is over $100 CI. This means that although doctors do set their own rates, they tend to only really vary much from the standard schedule when the underlying costs change. You’ll also find that most doctors of a certain type e.g. paediatricians, tend to charge within a very narrow range i.e. they are all similar.
I may be a very senior person but my rates are comparable to the other paediatricians on Cayman!
So, what do you pay?
The fee we charge (not that you pay – see below) is made up of the following:
- The consultation fee for the episode
- The cost of specific items used or consumed
It actually works remarkably similarly to having your car serviced – where you pay for labour and parts – just that the insurance company sets basic rates!
Your insurance company, depending on your insurer, generally pays 80% of the bill (for which we submit the claim on your behalf) and you are responsible for 20% called co-pay. The co-pay element is charged to you directly on completion of the consultation and we reclaim the remainder from the insurance company directly. Sometimes you will pay a little more than 20% and that is generally where there is an additional charge because the standard insurance company rates don’t cover the costs. If that happens with us, we will always explain that to you and have you, were possible, pay the full non-reimbursed bit whilst you are with us. This is to save you receiving your statement from the insurance company with the phrase “Charge exceeds Cayman Islands Legislated Standard Fee Schedule” and thus having to make a second, later transaction.
How does it work?
Generally, the following would be how it worked for a new patient (the only difference for existing is you are already registered):
- At reception, you’ll be asked to complete a brief registration form including your contact details, your child’s details and your insurance information (provider, card number etc)
(existing patients are asked to confirm nothing has changed)
- Reception will then verify your insurance cover, to ensure we charge you correctly on completion
- You’ll have your consultation, during which your records are updated
- This information is used to produce your co-pay bill and the insurance claim
- You settle the co-pay bill and the rest is up to us
On occasions, insurance companies have queries and we may have to contact you afterwards. It’s not that frequent but it does happen (and is out of our hands). Generally, most people simply see our work appear on their periodic health insurance statement.
Insurance Cover for Babies
It is important that you have organized the insurance for your new baby before they are born. All newborn babies are covered via their mother’s policy for the first 30 days of life. The only exception to this is where a mother is herself on her mother’s policy in which case the new ‘grandchild’ will need separate insurance organising before birth, or the family will potentially be responsible for all costs.
There are two sets of fees payable for a newborn baby – the hospital fees and the Paediatrician fees. These are completely separate. If you decide to have your baby cared for by a government Paediatrician, the Paediatrician fees still apply, are still the same but will be paid directly to the hospital.
Neonatal Intensive Care
Because of the high costs involved in neonatal care, parents are often very scared, specially when they see ‘limits’ getting close. However, in the vast majority of cases, parents are very adequately covered and once they reach certain limits they stop paying the co-pay element too (that doesn’t mean cover stops).
However, there are variations by insurance companies and so we are always very happy to confirm EXACTLY what you can expect, so there are no nasty surprises (beyond the obvious shock of needing neonatal care to start with).
Again, my rates, despite my seniority, are absolutely standard and the same as you would pay for an HSA paediatrician.
UNDERSTANDING CHARGES FOR NEONATAL CARE
If your baby is admitted to the neonatal (special care baby) unit there will again be two sets of costs. The first is to the hospital for the care provided by the neonatal nurses, the cost of laboratory tests, disposable items, equipment etc. The second cost is for the Neonatologist or Paediatrician. Again, if a mother decides to move to the government these two different costs remain the same, it’s just they are both paid to the hospital. Dr Watkin charges the same amount as the government paediatricians for care on the neonatal unit.
All insurance policies will cover for in-patient neonatal care, although you will almost certainly have a co-pay. It is important to refer to your maximum in-patient co-pay per year, so that you get an idea of what the maximum you are likely to be charged is, rather than worrying about being charged x percent of all the costs ad infinitum. I find it helpful for parents, once they have got over the initial worries and anxieties of a baby on the neonatal unit, to meet with both the hospital billing team and The Medical Clinic billing team to help them better understand the actual parental financial responsibilities and liabilities. Thisusually reduces parent’s worry and anxieties!
Please talk to us early if you are worried about the cost of neonatal care and we will do everything to help you understand your costs better and the various limits.
Health Insurance Companies in Cayman
The following is a list of the approved insurance companies in Cayman. You can check who is approved at any point through the Health Insurance Commission at the Department of Health Regulatory Services – Approved Insurers
We work with all of the major insurers. It is your responsibility to have valid health insurance and pay the co-pay element but it is our job to verify the level of cover, undertake any pre-authorisations and submit the claims.
Aetna Life & Casualty
Tel: +345 946 6611
BAF Insurance Company (Cayman) Ltd.
Tel: +345 949 5811 or +345 949 2011
British Caymanian Medical (Colonial) – BritCay
Tel: +345 949 8699
Cayman First Insurance Company Ltd.
Tel: +345 949 7028
Cayman Islands National Insurance Co. (CINICO)
Tel: +345 949 8101
Tel: +345 946 8464
Tel: +345 747 2000
Guardian Life of the Caribbean (Fidelity)
Tel: +345 949 5836
Pan-American Life Insurance Company of the Cayman Islands (PALIC)
Tel: +345 949 8304