One aspect of the impasse that caused Sidilega Private Hospital to suspend its services for members of the Botswana Medical Aid Society (Bomaid) was “reconciliations on financial amounts.”
The language is from accounting and the operative word in that phrase is “reconciliation.” The latter refers to an accounting process that compares two sets of records to check that figures in general, including financial ones, are correct and in agreement. Internally, Bomaid says that it was experiencing “technical challenges” in assessing claims. The net result was a delay in payments with all its medical services providers.
“We are glad to say that this has however been resolved as the payments process has since been activated two weeks ago,” Bomaid told Sunday Standard. “Regarding Sidilega, there were other differences due to reconciliations on financial amounts. We have been working tirelessly with the hospital to resolve this and are glad that we have found an agreement on a way forward that should allow us to move forward.”
It is probably not in good form to use a smoking metaphor in reference to health-oriented institutions but last Friday morning, Sidilega and Bomaid were smoking the peace pipe. Around noon, the Hospital posted another advisory to its Facebook page, announcing that it had restored its business relationship with Bomaid.
“We are pleased to announce that both parties have reached an amicable concordat on the matter and that from Monday 28 February 2022, normal business will resume for Bomaid members,” reads the advisory.
The part about the delay in payments affecting “all” medical services providers (in Bomaid’s own statement) reveals another aspect of this issue: that Sidilega was the only provider that decided to suspend its business relationship with Bomaid. The suspension happened last Monday and Sidilega attributed it to “the ongoing short payment of our hospital claims.” The announcement caused panic among Bomaid members and prompted Sunday Standard to ask Bomaid whether it had “differences” with any other private healthcare provider that it does business with. “Differences” was a word that Bomaid had itself used in response to Sidilega’s dramatic announcement. The company acknowledged that there were “ongoing differences with Sidilega Private Hospital that will impact service delivery.”
In response, Bomaid said that it has partnerships with a broad spectrum of medical health service suppliers. As far as we are aware, none of those suppliers has suspended business with Bomaid.
“The nature of the business is that there will always be differences between what the healthcare practice bills and what is paid. For example, in some instances a practitioner may bill for a procedure that is not covered or for a member whose account has been suspended, while in other instances members may have run out of benefits. These differences are most pronounced where there is no switching arrangement in place and the healthcare practice is unable to see the membership and/or benefit status prior to rendering service. In these cases, healthcare practitioners submit invoices in good faith, and these may be rejected, or amendments may be necessary. We appreciate that this causes anxiety on the part of the practitioners and may affect their cash flows.”
The company added that whilst challenges might arise from time to time, “consistent and transparent communication” with service providers has made for cordial relationships: “Our continuous engagement with them enables us to detect when and if, any challenges arise with our service providers.”
