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Windward Islands Medical Association: No willingness from St. Maarten Insurance Association to resolve medical card ban


~ Proposal sent after a year of deadlock ~

PHILIPSBURG–The possibly thousands of persons paying for private medical insurance are still going into their pockets for each visit to their house doctor as the Windward Islands Medical Association (WIMA) and the St. Maarten Insurance Association (SMIA) are still wrangling over a resolution one year after family practitioners stopped accepting the cards.

Cards not being accepted are NAGICO, Ennia, Fatum, Sagicor and Alico. Cardholders are required to pay cash up front and are given receipts to claim repayment from their insurance companies.

However, WIMA Chairman Hidde Deketh says there is no willingness from the SMIA to resolve the matter at the expense of patients as many are not claiming back their expense.

Deketh said the WIMA “finally” received a proposal from SMIA recently after a year of deadlock. “Last week, we posted our proposal back to them and we are currently waiting for their response,” Deketh said.

“The WIMA is just asking for inflation correction of the primary care tariffs unchanged as far back as 1999. I am afraid it is a waiting game again. Our action to refuse cards proves a bit ineffective because of the fact that the private insurers are saving massively by a decreased use of medical care/facilities/diagnostics and patients not claiming back their expenses. Hence, no willingness from the SMIA to resolve this at expense of the patients,” said Deketh.

SMIA Chairman Eric Ellis did not respond to an email enquiry requesting an update on the matter on Friday. Ellis had expressed surprise when the ban went into effect and had said that clients would have been kept informed on progress being made in this matter, however, no information has been forthcoming from SMIA since then.

Family practitioners stopped accepting the cards on September 27, last year, because they were unable to come to an agreement with the SMIA on a cost-of-living adjustment (COLA) payment.

WIMA has said in an announcement of the ban a year ago that it had been negotiating with the private insurance companies since 2009. The medical practitioners, who are members of the WIMA/SMA, said they no longer accept the private insurance cards because they had not received any COLA from 2000 to 2012, which they contend accumulates to a 130 per cent loss for general practitioners and a 130 per cent savings for insurers.

The associations also said that general practitioners no longer could absorb these losses while all other expenses kept rising at the same time. The long-term effect of these below-market-value rates is quantity and not quality care.

Doctors who are not accepting the private insurance cards are Dr. A. Arrindell, Dr. P. Arrindell, Dr. Bouman, Dr. Bus, Dr. Datema, Dr. Deketh, Dr. Dennoui, Dr. Douglas, Dr. Foeken, Dr. Herles, Dr. Knol, Dr. Mercuur, Dr. van Osch, Dr. Perez, Dr. A. Raghosing, Dr. R. Sanchit, Dr. Simmons, Dr. Spencer, Dr. Swanston and Dr. Tjaden.

Health Minister Cornelius de Weever had called the situation “discerning” after the ban went into effect last year and said that he would have tried to get parties around the table.

It was also announced that government intended to introduce new medical tariffs in January 2013 that would have taken inflation into account. It could not be ascertained whether these tariffs were introduced as planned.

De Weever had said at the time that the Policy Department of Public Health had been in the process of finalising a tariff structure that would have included services rendered by general practitioners, in which inflation would have been taken into consideration. This tariff structure had been developed in collaboration with the various health care providers, including the general practitioners.

Source: The Daily Herald, St. Maarten

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