A charity that treats people with heart conditions said it was no longer able to serve patients covered under the Government Employee Health Insurance plan without a monthly membership fee.

The Bermuda Heart Foundation said the change, which came after more than ten years, stemmed from an “unresolved billing issue” ‒ while the Government has said it still needed to receive essential details to resolve the matter.

In a message to members, the charity explained that from March 1, GEHI and pro-bono members who wish to continue to receive treatment under the Cardiac, Outreach, Renewal and Education programme may do so through a new membership programme for a $300 fee.

The Government said last week that it had requested a list of physicians and registered professionals who provide services at Core and said GEHI could not pay claims until the information was received.

However, a BHF spokeswoman told The Royal Gazette that a full list — with credentials and registration numbers — had been provided in December.

Core allows people at risk of heart-related illness to take lifestyle classes, join a support group and benefit from tailored exercise plans with the help of a cardiac fitness trainer, the BHF website said.

In its message to members, the charity said that since 2013, the programme was covered under a preapproved GEHI billing structure.

It said that when Core was launched, the insurance scheme was unable to add a new procedural terminology code for cardiac rehabilitation and prevention, since it would have required legislative changes and system updates.

A workaround procedure was adopted for more than a decade to ensure GEHI members received “critical” cardiac rehabilitation and prevention services.

The notice to members said: “However, since August 2024, GEHI has not reimbursed Core for your participation, citing an issue with the same billing structure they originally provided.

“Despite months of good-faith efforts to resolve this, we have not been offered a viable solution.

“Unfortunately, we can no longer sustain the financial burden of covering services for both GEHI and pro-bono clients without reimbursement.”

The Government said last week that the challenge related to the need for a list of physicians and registered professionals for Core services.

A government spokeswoman explained: “Core have been advised that services provided to clients and billed to GEHI need to align with the GEHI schedule of benefits, including the utilisation of registered professionals.

“Following complaints by GEHI clients about Core’s billing statements, the Government requested that Core provide a list of physicians and registered professionals who render services at their facility.

“Unfortunately, despite repeat requests, this information has not been provided and until it is, GEHI cannot pay claims to this provider.

“While we do fully understand how this programme can be a benefit to our clients, proper vetting is necessary to ensure we are complying with legislation.”

The charity disputed the claim and said that on December 16 last year, it submitted a full list — which was seen by the Gazette — of medical professionals working at its facility.

The list included their credentials and registration numbers.

The charity said its submission was acknowledged by the office of the Chief Medical Officer, which requested additional information about a staff member.

The Government said while the charity provided a list of board members, owing to inconsistencies in the submission, GEHI requested a list of staff and providers who are rendering the services at the facility.

It added: “We have not received that information.

“GEHI must comply with what’s legislated and properly ensure all service providers are registered by the relevant regulatory authority.”

A BHF spokeswoman said the foundation had a “decade-long” trail of e-mail correspondence and text messages with the Government on the matter.

She said the charity also sent correspondence to Kim Wilson, the Minister of Health, to discuss the problem, but did not receive a response.

The spokeswoman said the situation would have a negative impact on clients.

She added: “This financial stranglehold threatens the survival of Core’s full scope of work, impacting all patients — including those receiving pro-bono medical and rehab services.

“This isn’t a payment dispute — it’s a life-or-death decision that will force Bermudians to go without essential heart care.”

She said the charity had been committed to its clients’ health, their recovery and their ability to live full and active lives.

The BHF spokeswoman added: “To be forced into a position where we can no longer provide the care they need — simply because of bureaucracy and financial barriers — goes against everything we stand for.

“We are here to heal, not to turn people away.”

More than 400 clients covered by GEHI are enrolled in the Core programme, including seniors and people with no insurance.

The spokeswoman said 23 sessions for clients per calendar year were under insurance, which covers 80 per cent of the cost, leaving the patient responsible for the co-pay.

If a patient cannot afford to pay the 20 per cent co-pay, Core waives the fee or reduces it to half to ensure no one is denied care.

Nine free additional sessions are offered to ensure patients get the full benefit, the spokeswoman said.

Since the announcement about the change in payment structure, the charity has received calls from clients, many of whom said they could not afford the cost for treatment.

Peter Shaw, a pensioner, said the fee was beyond his reach.

Last October, Mr Shaw suffered a medical condition while riding in Hamilton and was assisted by passers-by who performed cardiopulmonary resuscitation.

He noted that the Core programme played a vital role in his recovery.

Mr Shaw said: “I have been going to Core gym for several years and along with walking, it is part of my fitness regimen.

“It has helped tremendously with my recovery from cardiac arrest six months ago. I cannot afford the extra costs as I’m on a pension.

“Unless a solution can be found, I will have to stop. It will be sorely missed.”