The Department of Health is now able to bill insurance companies for services rendered to clients for the first time since the Virgin Islands’ two hospitals became separate from the department in 1994.
Previously, if you had private insurance, you could use it to pay at the hospitals — which were part of the territory’s provider network — and at the public health clinics and private doctors. But if you received services directly from the Health Department — at the Charles Harwood Medical Complex on St. Croix, for example — you had to pay cash for service, even if you were insured. Now the provider network, V.I. Equicare, processes insurance claims for the Health Department automatically.
The move fulfills a goal Health Commissioner Julia Sheen set during her confirmation hearing before the Legislature. But Sheen credits Revenue Services Coordinator Lorna Miller with doing the legwork and making the transition happen.
"The ability to bill insurance and get reimbursed for client services is a major milestone for us and a win-win situation all around," Sheen said in the Health Department’s announcement of the change. "Our clients benefit through the convenience of using insurance cards as opposed to cash on hand, and the department is reimbursed at the insurance company’s fee-schedule rates, thus increasing revenues."
In the past, a very small percentage used private insurance to pay the Health Department, but they had to submit the paperwork directly to their insurance providers themselves. Those who did were reimbursed directly by the insurance companies, according to Miller. As a result, Health did not get reimbursed every dollar it was due.
So, with added convenience for insured clients and more reliable payment to the department, Health sees the change as a major win-win scenario.
Insurance payments will go to the Health Revolving Fund to pay for supplies, equipment and other materials necessary to continuously improve client services, Sheen said.
In other matters, Health’s Community Health and Family Planning clinics now have extended hours, from 8 a.m. to 7 p.m. Mondays on St. Croix and Wednesdays on St. Thomas.