News Middle East19 Jun 2019

UAE:Authorities to set strict guidelines on medical insurance payouts

19 Jun 2019

The Dubai Health Insurance Corporation (DIHC) is revising guidelines for medical insurance in the emirate and will put in place strict policies on the adjudication and settlement of medical insurance claims, according to Mr Saleh Al Hashimi, CEO of DHIC.

He made the comments to Gulf News which has reported that hospital operators in Dubai are facing delays in getting insurers to process and approve their claims. Hospitals have been voicing their concerns to the Dubai Health Authority (DHA).

Mr Al Hashimi added, “Having said that, the [insurance] payers and [health care] providers are two business entities that engage with each other in legally binding agreements.

“Therefore, they should know their rights clearly under such agreements.”

The DHIC is a part of the DHA. It helps regulate the health insurance market, create a conducive environment for growth and help maximise benefits to customers as well as protect their interests. At the same time, it keeps in mind the interests of insurance companies and third party administrators. DHIC is responsible too for managing the Dubai Government’s health insurance programme and issuing reports and recommendations related to health insurance and health economics.

In Dubai, insurance claim payments are taking well over six months and even stretch to as long as two years, as rejection rates shoot up, according to the Gulf News report.

Jobilal Vavachan, CEO of Aster Pharmacy and Clinics, said that the rejection rate by insurers has increased from less than 10% of all claims submitted in 2017 to 14% last year.

The increase should also be taken in the context of Dubai now having mandatory medical insurance for all, which has led to a surge in insurance claims filed by hospitals and clinics.

Mr Leigh Dauncey, sales leader at Mercer Marsh Benefits, said, “The ultimate solution is the digitalisation of the entire end-to-end process, which will have a positive impact, reducing the administration burden on providers and insurers and reducing the time spent on account reconciliation.”

 

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