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Update on the current situation between MAM and Insurers - 9/7/2003

As you are aware, MAM has been negotiating a new agreement with insurers with regard to maximum reimbursements. A tentative agreement was reached that these should go up by 10% on the previous BUPA agreement. However, the agreement has still not been signed, as the insurers, acting on their legal advice, decided that prior clearance from the Office of Fair Competition was needed. This may take some months.

The doctor is, as always, free to charge any fee he deems as being reasonable. As there is, at present, no valid agreement with the insurers on maximum reimbursement (the previous one having long expired), one would have to conclude that local insurers may or may not reimburse these fees in full.

The doctor may therefore wish to consider doing away with direct settlement (through the insurers) and instead bill the patient directly or through the hospital / private clinic where the patient was attended to. Both St. Jamesís and St. Philipís Hospitals have agreed to include the doctorís fee in their bill to the patient. Where appropriate the doctor should inform the hospital that he does want to make use of the direct settlement system.





Stephen Fava
President



 
 
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