The stand-off between two insurance companies and the Island's physicians only has one loser - the patient.

It has been alleged that the dispute boils down to money and there is some truth in that.

Both sides agree that Bermuda needs a new fee schedule that takes account of changes in medicine and both claim to be acting in the interests of the patient.

But the physicians have said the fee schedule the insurers wanted to introduce should cover more procedures and in some cases would cut their incomes.

The insurers disagree, saying that fees would generally go up by an average of seven percent. They acknowledge that some procedures would go up by less than that figure while others would go up by significantly more.

The insurers also say that they tired of waiting for the doctors to come up with an alternative proposal and introduced the new fee schedule on June 1. The physicians came up with an alternative proposal which the insurers claimed would see fees rise by an average of 21 percent.

At this point, Government became involved in efforts to mediate the dispute and attempted to persuade both sides to accept new fees that would rise by an average of nine to 12 percent depending on the speciality. This offer was apparently accepted by the insurers but rejected by the doctors.

The physicians were within their rights to do so, and Government then took the position that it could not impose the fee increases on both sides under the current legislation which requires that physicians and insurers agree before the Government makes the new fees mandatory.

As a result, Government has brought in a mediator to try to break the impasse, and the physicians announced they would directly bill the patients of BF&M and Argus from today. That move was stopped via a court injunction last night, but it is not clear how long that will last.

Still, the bottom line is that patients will be left in a state of uncertainty at some point in the near future. They will be required to call their insurers themselves without any clear idea of how much they will be reimbursed. At the same time, they will have to pay their insurers within 30 days. What happens if they cannot make up the difference - or the insurer refuses to pay for the procedure at all because it is too expensive - is anyone's guess.

But the notion of people opting not to have a medical procedure or ending up in debtors' court because they cannot pay for the procedure they did receive is repellent.

If the two sides cannot reach agreement, it raises the spectre of Government drafting new legislation that would enable the Minister to impose a new schedule. That is an option that neither side should want, because it could result in a Minister setting fees either so high or so low that doctors and insurers cannot remain in business. Again, the person who ends up footing the bill is the innocent patient.

Still, Health Minister Nelson Bascome is likely to go ahead with this plan and pass legislation giving him the power to impose a new fee schedule. If there is any reason left in this dispute, it should be used by the physicians and insurers to reach an agreement before Mr. Bascome takes that step.

It is not stretching the point too far to suggest that lives are at stake in the current dispute; both sides need to sit down and make an agreement both can live with rather than have one neither wants imposed upon them. In the meantime, physicians should bill insurers and insurers should pay claims just as they have for the last 30 years.