Argus/BF&M change coverage for Boston Children’s Hospital

Concerns have arisen regarding overseas medical care for Bermuda’s children, after Argus removed Boston Children’s Hospital from its Preferred Provider Network.

This means treatment at the world-famous facility may not be fully covered for Argus and BF&M clients on lower-tier plans.

However, the insurer has said that some social media comments on the matter are misleading, and offered assurance that those currently receiving a course of treatment at BCH are still covered.

Dr. Stephen West at Wee Care Pediatrics brought attention to the coverage change, stating on social media that it happened “without Argus even speaking to any of the pediatricians on island and without them speaking to anyone at Boston Children’s Hospital.”

“We only found out when we tried to refer patients to BCH after May 2025”, he said.

However, Pete Lozier, EVP, Group Head of Benefits at BF&M and Argus, countered that Dr. West’s office was notified prior to the renewal period.

Citing the relationships he has developed with pediatricians at BCH, Dr West said “it will be an incredible shame if Bermuda loses this incredible level of care.”

Mr Lozier sought to clarify the matter, saying that Boston Children’s Hospital remains part of the overall provider network for Argus & BF&M clients, but it is not included in a Preferred Provider Network plan, which is an optional lower cost tier.

Mr Lozier assured that clients already undergoing treatment at BCH can continue their care uninterrupted, under their continuity-of-care policy.

The PPN plan continues to have access to pediatric hospitals in Toronto, Halifax and Philadelphia, which have direct flight connections with Bermuda.

Boston Children’s Hospital was removed from the PPN plan, Mr Lozier says, as part of a recent evaluation.

He says, “our goal is to ensure Bermuda’s children continue to have access to world-class care while keeping coverage affordable for families and the system sustainable for future generations”.

Mr Lozier’s full comments are below…

Media response regarding Boston Children’s Hospital, from Pete Lozier, EVP, Group Head of Benefits at BF&M and Argus:

While this response specifically addresses Argus policies, it is important to emphasize that our overall network strategy and unwavering commitment to long-term healthcare sustainability applies across both Argus and BF&M. Our top priority is, and always will be, ensuring that our members have access to high-quality, evidence-based care, while at the same time protecting the affordability and long-term viability of Bermuda’s healthcare system.

We absolutely understand that healthcare decisions are deeply personal—particularly when they involve children. It is therefore unfortunate that some providers chose to share information on social media instead of reaching out to us directly for clarification. This has caused unnecessary distress and confusion within the community, especially since many of the statements being circulated are inaccurate and misleading.

We are proud to offer our members access to some of the world’s most respected pediatric institutions, while also pursuing responsible strategies to keep healthcare accessible and affordable for Bermuda’s families—now and into the future.

Key points to know:

• Boston Children’s Hospital (BCH) remains part of the overall Provider Network.
• For customers with Preferred Provider Network (PPN) plans, BCH is not included within this narrower network.
• Customers who are not on a PPN policy retain full access to BCH, with no change to their coverage.

What is the Preferred Provider Network (PPN)?

The PPN is an optional plan tier, developed in 2015 in response to employer and member demand for more affordable options. It includes a select group of high-quality, cost-effective providers, resulting in lower premiums and tailored support for members.

Even within the PPN, customers continue to have access to internationally recognised pediatric hospitals, including:

• The Hospital for Sick Children (SickKids) – Toronto
• Children’s Hospital of Philadelphia (CHOP)
• Nemours Children’s Hospital – Delaware
• IWK Health Centre – Halifax
• Mount Sinai Hospital – Toronto

Responses to specific media questions:

Why has BCH been removed from the PPN plan?

BCH was previously included in both standard and PPN networks. Following our recent evaluation, it was removed from the PPN as part of our broader network optimisation strategy, focused on cost-effectiveness, quality outcomes, and long-term sustainability of care.

Will coverage continue as normal for existing Argus customers currently receiving care at BCH?

Absolutely. Customers—or their children—who are already undergoing treatment at BCH can continue their care uninterrupted under our continuity-of-care policy.

Continuity of care means that when a member is in the midst of treatment with a specific provider who later becomes out-of-network due to a policy or network change, coverage for that provider will continue until the treatment or episode of illness is considered clinically complete. This ensures that members are not forced to interrupt treatment or switch providers during a critical course of care, particularly in cases involving complex or chronic conditions.

No one is required to change providers mid-treatment due to this network change.

Can you confirm the claim of 50% coverage reduction for BCH visits?

This claim is incorrect. Coverage levels vary based on the specific plan. PPN plan members may have different reimbursement levels for non-PPN providers, but there is no blanket 50% reduction. Additionally, those in ongoing treatment are protected under continuity-of-care provisions.

What was the previous arrangement?

BCH was included in both standard and PPN networks prior to this change.

Was Dr. West’s practice notified of this change?

Yes. While network configuration updates are standard across the global insurance industry and not always communicated to every overseas provider, in this case, Dr. West’s office was notified prior to the renewal period. We remain committed to engaging proactively and constructively with Bermuda’s pediatric community, whose work we deeply respect.

Is BCH the only facility affected by such changes?

No. We routinely evaluate all network providers to ensure alignment with clinical standards, patient outcomes, and financial sustainability. BCH is just one of several facilities reviewed in this process.

Have you received many complaints about this policy?

We’ve heard from a small number of concerned members and providers. We welcome open dialogue and remain committed to making sure our members fully understand their benefits and options.

Is this decision in the best interests of children and their families?

Yes—wholeheartedly. Our goal is to ensure Bermuda’s children continue to have access to world-class care while keeping coverage affordable for families and the system sustainable for future generations. PPN plans still include globally renowned pediatric institutions, and we continue to honour continuity-of-care protections.

Is there any consideration of reversing or rethinking this policy?

We constantly review our network design based on data, clinical outcomes, and feedback from our members. If future evidence supports change, we will evaluate it seriously. In the meantime, we remain absolutely committed to transparency, quality, and ensuring uninterrupted access to the care families need.

Closing comment:

We welcome dialogue with our providers and community members. We remain open to future network changes if clinical data and member needs support doing so. What we ask is that conversations begin with facts, not fear.