ST. CROIX — Limited insurance coverage and reimbursement barriers are complicating access to specialized healthcare for women and girls in the Virgin Islands, according to Dr. Sascha James-Conterelli, a Crucian healthcare provider who recently opened a private practice at Sunny Isles Medical Center.
A sixth-generation Crucian and director of the Nurse-Midwifery Program at New York University, Dr. James-Conterelli said her goal in returning care to St. Croix is to “ensure that there's comprehensive, seamless care for women and children.” Her practice provides services including OB/GYN care, postpartum support, holistic midwifery, breast and cervical cancer screening, weight management and depression screening, among others.
Part of that model involves a partnership with a mainland provider so patients requiring specialized treatment can be transferred or seen outside the territory when necessary. Dr. James-Conterelli said the arrangement is intended to ensure patients can be “seamlessly transferred or seen if they are high risk, and they need that extra care, or they need [gynaecology] surgery that is not offered here in the Virgin Islands.” She also works with local providers and refers patients according to their needs, including those requiring mental health services.
The broader objective, she said, is to reduce some of the anxiety residents experience when trying to obtain care that may not be readily available in the territory. Those difficulties, however, extend beyond the availability of physicians and other healthcare professionals.
Dr. James-Conterelli said one contributor to the territory’s provider shortage is the longstanding pattern of Virgin Islanders leaving for education and remaining on the mainland because of wider professional opportunities. Healthcare workers are among them, she said, “where we know we can get more money stateside for providing healthcare services than we can get in the Virgin Islands.”
But compensation from employers is only part of the problem. Dr. James-Conterelli told The Consortium that since establishing her practice this year, she has yet to receive any health insurance reimbursements for the patients she has treated.
She described the territory’s insurance environment as involving significant “gatekeeping” and said both the scope of coverage available to patients and reimbursement for providers need improvement. “Our healthcare insurance in the Virgin Islands has to be better and needs to come up to par with stateside,” she said. While commercial insurers provide coverage, she added, “there's a big gap in what is covered for many of the folks here in the Virgin Islands, and reimbursement also for providers here in the Virgin Islands.”
“If we are being treated as though we're subpar than stateside and we are still part of the U.S., that's unacceptable,” Dr. James-Conterelli said. Ultimately, she argued, the consequences fall on patients “because they're lacking the ability to have access to services in a timely fashion.”
She characterized insurance gatekeeping as a problem extending beyond the Virgin Islands, but said its impact is magnified locally because the territory already has fewer healthcare providers and fewer alternatives when specialized treatment is unavailable.
On the mainland, she noted, a patient who cannot obtain a particular service nearby may be able to drive across state lines to another provider. For a Virgin Islands resident, comparable care can require airfare, lodging and additional daily expenses, placing another financial burden on patients already navigating medical needs.
Even when the required procedure can be performed locally, Dr. James-Conterelli said insurers can still determine whether it will be covered. “If the surgeon says yes, I want to do this surgery, I can do this surgery here in the Virgin Islands, and the insurance company says, ‘Well, we don't see the justification for that’…What do you do then?” she asked.
Despite those obstacles, Dr. James-Conterelli said she remains committed to expanding access to care for women and girls in the territory. Her practice is intended to provide more services locally while maintaining referral relationships for patients whose conditions require treatment that cannot currently be provided in the Virgin Islands.
