ISLAND doctors are so 'fed up' with a Government insurance scheme they are now bypassing the system ¿ by demanding that patients pay for appointments upfront.

The Health Insurance Plan (HIP), designed to provide insurance cover for the less well-off, has been riddled with administrative delays for a number of years, creating a backlog of claims which has left practitioners out of pocket.

Although the Department of Social Insurance moved to clear the backlog earlier this year, doctors claim they are still waiting for hundreds of thousands of dollars in claims to be paid.

And at least one surgery is now refusing to accept HIP claims. Instead, patients are being told to pay for their treatment and submit their own claim to Government.

One patient told the Mid-Ocean News how she was told to pay upfront following a recent appointment with her doctor.

"At the time I had a medical assistance card and yet I still had to pay ¿ it's disgraceful," the woman, who asked not to be named, said.

"I believe the system is at fault ¿ it was initiated without everything being in place beforehand.

"We were told by Government that doctors would be taking patients from the Medical Clinic but they obviously made that statement without checking their facts. I just can't afford to go to a doctor any more, either a family doctor or a specialist.

"Paying upfront is the same for all HIP patients, whether you have regular HIP which you pay for yourself or medical assistance HIP which Government pays for ¿ but it's particularly bad if you're on medical assistance because funds are scarce. If doctors want their money upfront and expect the patient to claim it back, it can be up to two months before you get reimbursed.

"It boils down to the problem with HIP because, if the department paid the doctors on a timely basis like other insurance companies, doctors would not be acting like this."

The woman said she sympathised with doctors who still had not been reimbursed for bills that were years old, but criticised the fact that patients on medical assistance were being penalised.

"They need to bring more people in to administer HIP so that claims can be processed. Doctors need to be paid on time so that HIP can work the way it's meant to work," she said.

One physician confirmed he was aware that "one or two" practices were now bypassing HIP, but added that it was not a widespread policy.

"The problem is there has been no audit on HIP and yet the amount of money that must be being paid in is considerable," Dr. Robert Martin, of Island Health Services, said.

"Our practice is owed about $100,000, although it was as high as $200,000 six months ago.

"We would receive a cheque for, say, $7,000 but there was no reference or reconciliation to the bills ¿ we had no idea what patients or bills that money refers to.

"We don't refuse treatment but this shows how serious the problem is. We're all just completely fed up with it.

"There is a solution ¿ they need to bring in a huge amount of manpower. If they have tonnes of bills sitting in cardboard boxes, which is what we've been told, then they need to address that with extra resources. It's a very badly managed department at the moment."

But Department of Social Insurance director Karen Daniels insisted that the problem was being worked on.

"I cannot comment on the matter at the moment because we are not computerised.

"But we are undergoing a project of claims backlog and are trying to resolve the problem. Because we are dealing with volumes of paper we are unable to give a snapshot of what we owe at the moment ¿ we really can't give any information out without the benefit of a computer system but I know that we are becoming more and more current."

But last night Shadow Health Minister Louise Jackson said the system had been in chaos for years and was now undermining the dignity of patients.

And she pointed out that administration set up to handle the Government Employer Health Insurance programme was fully computerised and running smoothly.

"The UBP has repeatedly called for this health care plan to be computerised and made workable," she said.

"It is very disheartening to know that the Medical Clinic has closed, many patients still haven't found a doctor, and those that have are forced to pay far more than the $5 fee that Government promised. The average bill is anywhere between $40 and $130, which precludes many patients from being able to see a doctor at all. How dignified is it for people to have to go without medical care simply because they can't afford to pay upfront? It is also criminal that doctors are owed hundreds of thousands of dollars and are having to wait years to be paid. The whole insurance plan is inadequate. We need the Medical Clinic back and further clinics throughout the country."

Yesterday, a spokeswoman for the Ministry of Health said: "It is no secret that HIP has been behind in payments for some years. That said, there has been an aggressive project under way over the last seven months to address this backlog. The project has involved the hiring of additional staff, the implementation of an interim software solution and process mapping to improve efficiencies within the Department of Social Insurance.

"We are extremely encouraged by the progress that has been made. There are still some out there who we have not gotten to yet but we will get to them soon. We set a target at the beginning of the project of one year to get on a solid footing with claims payment, we are on track to achieve that. For every one physician you can find who might have a concern about payment, we believe that there are two others out there who could report that they have seen an improvement.