The National Health Insurance (NHI) has implemented a new policy that limits the number of times its beneficiaries can make visits to medical practitioners per month.
A media release from the NHI this week said beneficiaries will now be allowed one primary visit and a maximum of two follow-up visits for a specific diagnosis within a thirty-day timeframe.
“If further visits are required for the same diagnosis, NHI must be notified in this regard and additional visits may be granted on a case-by-case basis. NHI reserves the right to recommend a second opinion or referral to a specialist for the beneficiary if deemed necessary or if one was not previously sought by the practitioner providing service,” Manager of Beneficiary and Advisory Services, Casandra Lewis explained.
She added: “The goal of the policy change is to ensure all beneficiaries receive quality care with a view to improved healthcare services throughout the Virgin Islands, along with adequate fiscal responsibility of the NHI fund.”
Meanwhile, Medical Director Dr Harlan Vanterpool alluded to past cases to further explain why this new measure is necessary.
“In some cases reviewed by NHI, it has been found that some providers have not been through enough in their medical assessments of beneficiaries, resulting in the misdiagnosis of beneficiaries, and by extension, the commencement of treatments deemed inappropriate. In some of these cases the needed specialist input was not sought in a timely manner,” Dr Vanterpool said.
He further said: “This has resulted in patients seeing the same physician repeatedly, continuing with the same treatment, and not seeing any improvement in their condition. Again, in these cases, beneficiaries are not receiving appropriate care, which may result in their conditions worsening or they may also develop other issues associated with being administered inappropriate treatments.”
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