Pressing need for better health insurance coverage - Saudi Gazette

Pressing need for better health insurance coverage

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Makkah

IF insurance companies had responded to claims of healthcare providers properly in accordance with medical insurance policies they should have paid more than $1.5 billion to healthcare providers in the public and private sectors, thus contributing to further improving health services in the country. But insurance companies were playing tricks to avoid payment.

A health insurance card holder approaches healthcare providers with the hope that he/she would receive necessary coverage for treatment of diseases. If they can satisfy the client, it will provide free publicity to the insurance company as people will be talking about its services.

However, when we monitor insurance procedures closely, we find that many customers do not receive required health services and this goes against the claims of insurance firms.

When we criticize medical insurance services we don’t talk about the origin of the harsh and unfair conditions and the lack of insurance awareness and culture of health insurance, but we talk mainly on the pain of applications being rejected or insurance company’s response being delayed or about poor professionalism of staff members who deal with customers.

People will have different experiences with insurance companies. While giving extra efforts to make claims and collect money from clients they provide little care toward ensuring required coverage for their clients. Most people want to avail of their medical insurance rights but often they become victims of tough insurance procedures and other negative practices.

The health insurance community is full of insurance cards that are required to obtain resident permits for expatriates and get access to services of the Passports Department, labor office, recruitment office and other government agencies. Quite often health service providers give little value to these cards and treat them differently, depending on the insurance company it issued them.

I believe that it’s not the right of an insurance company, which has signed a contract with the Ministry of Health and a group of service providers to refuse a client’s treatment request without giving a genuine reason consistent with the general contract’s terms and conditions. In most cases, patients who require urgent treatment will not be able to wait for long to get insurance approval.

The Health Insurance Council monitors insurance companies and exerts great professional efforts to cope with the latest developments and tackle mistakes of companies. However, this is not enough in the field of medical insurance to cover the value of treatment. There is a pressing need for enlightening the public about their insurance rights and obligations.

Insurance companies make a lot of mistakes in paying dues to clients due to their own negligence in giving approval to treatment claims. It’s the duty of an insurance company to give a reply for such claims within a few hours, either positively or negatively. If it does not reply within the specified time means its final approval.

I have written earlier about the need of a specialized court to deal with insurance-related issues and protecting the rights of clients. Today, after a working session with an insurance specialist it has become clear to me the need of qualified and experienced insurance advisors at government and private institutions to protect the rights of insurance card holders.

How many patients and their families have become donors to cover the treatment cost after insurance companies failed to pay their bills citing different reasons. This underlines the need for a third sector of volunteers, donors, support institutions and charities to back patients who require rare operations and complicated surgeries involving huge expenses. Such a system would make healthcare services more qualitative and flexible.

I have heard about an insurance broker and its service package that goes in line with the rules and conditions set by the Saudi Arabian Monetary Agency (SAMA), the Kingdom’s insurance regulator. Another expert told me about a gateway of insurance services that many insurance cardholders are unaware of. I was very sad after knowing the fact that insurance companies have been doing injustice to our patients and public health care providers without telling us about insurance brokers who inform clients about best insurance options and how to protect their interests.


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