Private insurance companies not paying Gesy for accident hospitalisations

The Health Insurance Organisation (HIO) is looking to cut a deal with private insurers on how to divvy up hospital treatment costs, it emerged in parliament on Monday.

HIO director Andreas Papaconstantinou told MPs that for a year now his organisation has been grappling with a ‘loophole’ in the legislation governing Gesy, or the national health scheme.

The HIO is the agency tasked with running Gesy.

It turns out that in the event of a car accident, where a person is injured and requires hospital treatment, the costs end up being covered by Gesy, instead of the insurance company of the driver responsible for the accident. This happens where the injured person is enrolled with Gesy – most people are.

Moreover, where a person requires hospitalisation, his or her private insurance company will cover the cost only when the hospital where care is provided is not enrolled with Gesy.

On this point, MPs heard that in Nicosia just one hospital is outside the Gesy system. In Limassol there are none – all hospitals are part of Gesy.

From then on, and depending on the private insurance policy, an insurer may cover either the co-pay for a doctor’s appointment (where the doctor works within Gesy) or for hospital treatment overseas.

This is because according to the law governing the national health system, a doctor and/or hospital enrolled with Gesy cannot receive payment for services from anyone else other than the HIO.

Papaconstantinou said the matter has been on the HIO’s radar for the past year, with the organisation seeking an arrangement with the Insurance Association of Cyprus (IAC).

The issue gets particularly tricky when it comes to professional drivers involved in vehicular accidents, or in cases of work-related accidents, as following such an accident the injured person more often than not ends up in either state hospitals or in private hospitals enrolled with Gesy.

The HIO director said he has sought and got a legal opinion that the HIO may claim from insurance companies the compensation for hospital costs. He said they have approached the IAC and asked for an agreement between the two, where the IAC would pay a one-time sum as an offset.

This sort of blanket arrangement would obviate the need for red tape – such as the HIO and the IAC haggling over who pays what on a case-by-case basis.

For his part, the IAC’s Andreas Athanasiades said insurance companies are willing to pay compensation to the HIO. He pointed out that, at any rate, they used to compensate public hospitals prior to the introduction of Gesy whenever a client of theirs happened to be hospitalised.

He claimed that so far they have not paid anything to the HIO, and that this is because the latter have not asked for something specific.

Irini Charalambidou, chair of the House human rights committee that discussed the matter, gave the interested parties two months to hammer out an arrangement.

Speaking to journalists after the committee session, Papaconstantinou said he was optimistic about finding a solution.

The aim, he added, is to come up with a simple formula so that a part of what Gesy pays whenever someone is insured with a private company, returns to the Gesy coffers.

“What we won’t do, however, is create an army of employees who will hunt down each and every separate case so that Gesy gets back a part of its expenses.”