Saudi Gazette report

RIYADH — The Council of Cooperative Health Insurance (CCHI) has ruled that charging the costs of medical services in cash from the customer before receiving the approval from the insurance company is a violation of executive regulations of the cooperative health insurance law, committed by the health service provider.

In a statement, the council stated that the insurance client must not pay any amount of money other than the approved percentage of the treatment cost as per the insurance policy.

Yaser Al-Maarek, spokesman of CCHI, said that the council has detected several violations in this regard. “The council has referred several violations that were monitored through the supervisory bodies to the committee that examines violation of the provisions of the law,” he said while calling on healthcare service providers to adhere to the circulars and decisions issued in this regard and to provide healthcare to the clients in accordance with the executive regulations.

The council spelled out the cases that required a medical approval before extending medical services to the customers. These include treatment in an outpatient clinic if the one-time treatment cost is more than SR500, or cases of hospitalization, including single-day cases and surgical cases.

Al-Maarek clarified that emergency cases shall be treated directly and do not require prior approval by the insurance company, provided that the health service provider shall inform the insurance company within 24 hours of receiving the case. He indicated that 60 minutes is the maximum time to respond on the request for insurance coverage and the completion of the transaction between insurance companies and health care providers including hospitals and medical centers.

“If the health insurance company’s response is late for more than that period, it will be deemed to agreeing to health service cost in accordance with the cooperative health insurance law and its executive regulations. Similarly, health service providers are obliged to respond to any inquiries or comments by health insurance companies within a period of time that does not exceed 30 minutes from the time of receiving it,” he said.

Al-Maarek urged the insured clients to know and get acquainted with their insurance rights and identifying the benefits stipulated for them in the cooperative health insurance law and its executive regulations. He called on the customers to contact the council for submitting their suggestions and lodging their complaints through one of the following channels: The uniform toll free number: 920001177; the electronic portal: www.cchi.gov.sa; email: infocchi.gov.sa; smart phone applications in addition to the social media outlets (Twitter, Facebook, and LinkedIn) on official pages of the council: cchiksa.