Claims and Regulations – Bermuda Health Council

What do I do if a healthcare provider tries to charge me for the entire cost of the visit including the insured portion?

You should advise the Bermuda Health Council and provide details of the service you received and your insurance plan. Ideally ask the provider to make the request in writing or pay the bill if you can and keep the receipt as proof of the upfront payment. Patients are also advised to inquire about the cost […]

Are any providers exempt from Claims Regulations?

Some health service providers have been granted an exemption from the regulations and are able to charge patients upfront for the full-service cost. These are usually small businesses that are unregulated or do not have the infrastructure to generate and submit claims. Please contact the Health Council to inquire about specific exemptions. […]

Are claims required to be submitted electronically?

There is no legal requirement for claims to be submitted electronically, however the Claims Regulations encourages it as a standard. Electronic claims are more efficient and result in faster processing and payment. Health providers are encouraged to liaise with insurers to test their electronic claims systems for compatibility. All electronic claims should be submitted in […]

What are upfront payments?

The term “upfront payment” refers to the requirement for insured patients to pay 100% of a healthcare bill at the time of receiving services despite a portion of the bill being eligible for coverage under patient’s health insurance policy. The potential consequence is some insured persons avoid seeking care or experience family cash flow problems […]