Info boss backs FOI refusal

| 08/08/2010

(CNS): In her latest appeal ruling the information commissioner has ruled that CINICO is not required to comply with a freedom of information request as it would cost too much. The Cayman Islands National Insurance Company had refused a request for a list of approved in-network providers on the basis that it was vexatious and would unreasonably divert its resources. In her ruling Jennifer Dilbert said that the request was not vexatious but, given the size and cost of producing the list, it would be unreasonable. However, the information boss pointed out concerns she had about procedures during this case, saying it was vital that all parties respect her statutory powers to inspect documentation and investigate the matters before her.

Dilbert pointed out that there were problems on both sides in this appeal. In the first instance the
applicant did not provide a formal submission for the appeal and, as a result, the applicant’s correspondence was used instead. On the part of CINICO, Dilbert said an important policy document was missing from its submissions, which had to be requested by her office.  
“In the interest of fairness, clarity and expediency, it is of the utmost importance that the established hearing procedures are adhered to by all parties, in terms of timelines, formats and methods of submissions. It is vital that all parties understand the process, apply it correctly, and respect my statutory powers to inspect documentation and investigate a matter before me,” she said.
On examining the case, Dilbert said that the accusations by CINICO that the request was vexatious because the applicant did not attempt to work with the Information Manager were unfounded. CINICO had accused the applicant of not cooperating, of invoking their right to the information, not acknowledging the information manager’s recommendations and demonstrating a conflict approach. CINICO also said the applicant had a history of confrontation when requesting documents from the department.
However, the applicant said they had simply requested information that CINICO had already agreed in its signed and approved planning document, would be provided on its website.
Dilbert pointed out that the UK Information Commissioner’s Office advises that to judge a request vexatious, a relatively strong argument should be made and that CINICO had not provided any evidence that the applicant had a history of confrontation in requesting documents.
“It must be remembered that the Law requires that it is the request, and not the requestor, that is vexatious,” Dilbert wrote. “The Applicant has a reasonable expectation that the information was promised on the CINICO website and should be readily available. I do not find that the request can be deemed to be vexatious.”
However, because the law states that a public authority is not required to comply with a request where compliance with would unreasonably divert its time and resources, the information commissioner upheld CINCIO’s refusal.
According to the government insurance firm it would cost around $30,000 to produce the list, which would be a document of some 100,000 pages. Dilbert found that it was clear the number, type and volume of records falling within the request are very large, and the work time involved in fully processing the request would be great.
“I am somewhat sceptical of the cost estimate of $30,000 that was quoted to produce the list of in-network providers. However, I am of the opinion that if CINICO was even required to pay half the quoted amount, this would only serve to create a document that would soon be outdated and hold little or no value to either one applicant or the general public. The production of this document would be an unreasonable diversion of resources of CINICO,” she said in the ruling.
Despite her ruling, Dilbert told CINICO to look carefullyat its published Plan Documents and website to ensure that no potentially misleading information is given, and that it is clear to plan participants what documents can be supplied.
This was the second ruling by the commissioner in which she has upheld a refusal to give information. Dilbert upheld the decision of the RCIPS to withhold documents relating to Operation Tempura on the grounds of legal professional privilege.
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  1. Anonymous says:

     If I understand this correctly, the person just wanted to make an informed decision regarding their medical care.  What is wrong with that?  

    We should have a list so that if we go overseas and get sick, we would know exactly where to go without having to call people.  Maybe, the person could narrow the list down to a certain area but then again whose fault is it but CINICO that’s false advertising saying that it’s on the website and it isn’t.  That wouldn’t fly in any other country.

  2. Anonymous says:

    As mentioned by another writer, any bonafide Preferred Provider network should be available electronically and/or can be printed front and back of the paper in small font to use as few pages as possible. Which would lead one to believe that a bonafide PPO network is not being used and that possibly the CINICO patients are solely being steered to facilities and/or physicians of the administrators’ choice,  probably based on low costs, (hopefully service and good outcomes come in there somewhere) and not upon the physicians’ or patients’ choices, and being kept private for whatever reason, and thus their hesitation & refusal to produce any listing. At the least a list of physicians and facilities used by CINICO patients in the last year or quarter could have been provided.  I would assert the FOI was led far astray in their FOI mission in denying this request.  Civil servants have a right to know what facilities are available and/or are being used for the medical care of themselves and their loved ones.  I thought CINICO existed to serve the medical needs of the Caymanians who fall under its umbrella, not to make profits and/or operate under a cloak of secrecy on the backs of the people.  In this instance, I would say that the FOI has let CINICO be vexatious!  

  3. Anonymous says:

    The amazing part of this issue is that apparently neither CINICO, nor Ms. Dilbert, nor the applicant, knows the proper definition of "In-network provider".  An innetwork provider is a services provider which has a contractual agreement with an insurance company to provide services to the insurer’s clients, for reimbursement at a negotiated rate. A company which has in-network providers would certainly have a list of such providers!

    If CINICO decides on a case-by-case basis if a provider is to be approved for services then they actually have no in-network providers. If they do have contracts in place, then it is impossible (or unbelievably dubious business practise) that they do not have a list of such providers and cannot easily provide such a list. Every insurance company I have dealt with or inquired about plans with has their list of in-network providers available in an online database (usually query-able by area and specialty) or will provide such a list upon request. 

    If a patient has a particular physician and/or facility in mind, and that provider is not "in-network" many good insurance companies, with advance notice, will try to work out arrangements for approval and negotiation of fee reimbursement beforehand. Which is another fishy part of this. If the FOI petitioner has a potential condition requiring possible emergency or urgent attention then I would proffer that it would in his/her best interest to choose a potential provider well in advance and before the need becomes urgent! The usual method to parse providers is to determine the probable geographical area (city) and the required specialty. That can often narrow the list to a  dozen or fewer providers if the field is highly specialised. Then work with CINICO to narrow the list to those who are in-network or who would be approved for payment under the terms of the policy.

    The FOI question I would pose is whether or not CINICO even has a "network" of providers with whom they have "negotiated-settlement" agreements and schedules in place. If they do, then I fail to see how it could possibly be the least bit difficult to provide a copy of the list of said providers. 

    Having been involved in the financial services industry herself I should think that Ms. Dilbert would be a bit more savvy in her response to this request. $30,000?? No way, Jennifer!

    I fail to see where compliance with this request "would unreasonably divert  (CINICO’s) time and resources". If they have "in-network" providers, then surely there is a list somewhere and only a dunce would believe it would cost $30,000 and "divert time" of any consequence to produce.  If they do not have in-network providers, then the logical answer would be "We do not have In-network providers".  Done!

    The horror here is the possibility that CINICO has a cadre of in-network providers but has no record of who the hell they are. (Maybe CINICO lost the list and it actually will cost $30K to rebuild it!)

    The other horror is that they do have such providers and actually believe the list could cost $30,000 to produce – in which case I can see them agreeing to settling a patient bill of, say, $3000 for just aspirin. 

    Or, perhaps the CINICO folks are so ignorant and incompetent that no one at CINICO knows what an "in-network provider" is! (That would not surprise me.)  So far they are not looking to sharp on the issue.

    Something is not right here! As the public interest is involved I think Ms. Dilbert (or somebody) needs to come clean and get to the bottom of what’s going on. We need to know the truth!


    • Anonymous says:

      Dear Jesus, thank God for a post (at long last) on CNS about a subject that is literate and articulate, well informed, not bigoted and aggressive and sets out arguments on several sides for people to think about.

      As someone who knows the shambles that is CINICO, I commend this poster for evenhandedness.

    • Slowpoke says:

      You are totally right about the "in-network" definition.

      However, CINICO does not necessarily negotiate directly but has a contract with CNM (or something similar), who negotiate with overseas service providers and resultant costs, on their behalf. 

  4. Anonymous says:

    Why didn’t they just pass the cost on to the person that wanted the information? Maybe then we’d get a true, justified cost and it wouldn’t cost CINICO anything if the applicant wanted to get it.

  5. Balanced View says:

    Perhaps the request was denied because there is NO in-network arrangement.  HMOs and PPOs have in-network arrangements and other well run private insurance companies.  As far as I know the way CINICO operates is as follows:  If a referral is provided by a Dr here at the GT hospital they will make you go pretty much anywhere you need to get the necessary treatment.  Most patients are referred to the USA  – mainly Florida and Texas.  I have never heard of anyone going to Europe, Asia, South America, Africa or Australia for treatment. That eliminates approx 2/3 of the entire world’s land mass.

    If there was an in-network list I can tell you it wouldn’t cost 30k to produce and a case of paper.  Most insurance providers HMOs etc can provide this info electronically and if you need a printed copy you may use 15-20 pages of paper. What this decision suggests to me is that there is no network; any institution/private physician willing to take CINICO (which is another name for Cayman Govt backed Ins)  is part of our ‘network’.

    The reason CINICO felt that the request was vexatious is that they don’t want this to get out.  This info would only illustrate how inefficient they are in running their service.


  6. Anonymous says:

    How about an accounting of all off-island expenses…including referral expenses incurred locally?

  7. Beachboi says:

    I agree that to provide a world wide list of in-network providers might be annoying (vexatious), but surely the applicant did not want this entire list.  Even if they did how could it possibly cost $30,000.00 to compile the list.  Could it not simply be generated from a computer, and how could it possibly be 100,000 pages long??  The only facility in Cayman that accepts CINICO is the GT Hospital.  No other indipendent facilities or doctor’s accept the CINICO coverage so again how comprehensive could this list be?

    • Anonymous says:

      CINICO is not only accepted in Cayman, but worldwide with approval. Therefore, the list could turn out to be extremely long.

      • Anonymous says:

        This is information that should be readily available at the touch of a button. If there is no existing database of in network providers that would be an appalling failure by CINICO. I cannot imagine how the cost of providing the information could reach into 10s of thousands of dollars.

    • Jenna Jameson says:

      I really don’t have any faith whatsoever in CINICO. However, CINICO will be accepted by other doctors if GT Hospital has provided a referral letter. Basically if there’s anything too complicated for GT Hospital, like taking blood or trying to get you an ultrasound within the next ten years, you get a letter to go to a different doctor. The more you know . . . .

    • Anonymous says:

      Beachboi – the list that the applicant requested was for worldwide in-network providers – not Cayman ones 🙂

    • Anonymous says:

       I was wondering the very same thing.

    • Anonymous says:

      According to the article and the ruling the applicant did in fact want the entire list. And as others have pointed out, if there is a referral from the GT Hospital many other private doctors, including internationally, accept CINICO coverage.

  8. Anonymous says:

    A sound decision, I think, by Mrs Dilbert, taking everything into consideration. FOI is of course important but alas it appeals to the gossipy mischief making negative side of certain disgruntled dont have enough to do Caymanians, many of them in the civil service, and making "Michael Rodent" type FOI applications just to embarrass the department and bosses they themselves work for.

    • Anonymous says:

      I was the one who made the request.  The document I was led to believe was an existing document maintained by CINICO (as expressed in their policy document and which according to the same document was to be posted to their website).  It was not vexatious.  If I required overseas treatment I wanted to know to whom I could be refered.  I was not willing to accept CINICO’s "recommendation" of whom I could see but make the decision for myself.  Given that care might be immediately required I didn’t want to have to wait to get the list "sometime in the future" if such a situation were to arise.  As their own internal document led me to believe it already existed, Iam still dumbfounded that my request for information was denied and then upheld by the Commissioner. 

      • Anonymous says:

        get your own private insurance then…you can choose where to go with a private insurance provider.  CINICO costs the government and the general public.  It is free to you, so beggars can’t be choosers!

        • Anonymous says:

          Civil servants are forced to accept CINICO – they have no choice.  I would be happy to pay for health insurance if I could opt out of CINICO but that is not permitted. 

          • Anonymous says:

            I would be happy to pay for health insurance if I could opt out of my employers plan, but that is not permitted either…. if I want to keep my job.

          • Dirk says:

            While you can’t opt-out of having CINICO coverage you most certainly can pay for your own private health insurance (and honestly, quite a few civil servants do that I know personally), even if your spouse does not have private insurance to add you on as a dependent. Your employer (i.e. Government) just won’t pay half of the monthly premium. If you’re happy to pay for health insurance no one is stopping you.

          • Anonymous says:

            Then find another job.  If your health insruance provider is very important to you, then the complaining would stop and you would do something about it. 

            You can get and maintain health insurance coverage outside of the cayman islands which has no bearing on your local Cayman Islands insurance coverage. A little research goes a long way.

            BTW not all CINCO participants are Civil Servants.

            And as a civil servant free health insurance is a perk.  Be grateful!

      • Anonymous says:

        Your time in submitting the FOI request would have been better spent identifying a potential providers for your treatment. You could start by determining the probable geographical area. Then you could have parsed through the best specialists in the required field in that area.

        Once you had a "short-list" of specialists/facilities, you could have submitted it to CINICO and see what providers would be approved. Do you have such a list? If not, then I would think  your need for proper care must not be as potentially urgent and critical as you imply.  What would be the basis of your decision if you do not first have a short-list of potential providers? When overseas treatment is a possibility my first priority is choosing a good health care provider for me or my family.  If you do have such a list, then why not simply provide CINICO with the list and see if any can be approved.

        It just appears to me that the tail is wagging the dog in your case.