20 thousand dirhams fine for delaying approval of insurance applications without excuse

Patients confirmed that they had to wait a period of time that could sometimes reach a week to obtain the approval of health insurance companies to conduct the required medical examinations, which delays the diagnosis of the disease, and puts the lives of some of them at risk, while the Dubai Health Authority confirmed that the health insurance system guarantees a response to insurance requests. Within seconds, the law imposed a fine of 20 thousand dirhams if the company was late in approving insurance applications without a clear excuse or reason. A survey conducted by “Emirates Today” showed that 66% of participants had a worsening of their problem due to waiting.

The Executive Director of the Dubai Health Insurance Corporation, affiliated with the Dubai Health Authority, Saleh Abdul Ghaffar Al Hashemi, said that the current insurance system is designed to ensure that approvals for health insurance applications are completed within a few seconds of entering the application, while the delay in deciding on applications results either from a defect in entering application data or The company needs more information.

Al Hashemi explained to Emirates Today that the law specifies a fine of 20,000 dirhams in the event of refusal, abstention, or delay by the insurance company or claims management company in issuing its approval to provide a health service to the beneficiary, without an excuse accepted by the authority.

He said that the unjustified delay by insurance companies in responding to insurance claims is a clear violation of the law, and exposes the company to a fine estimated at 1,000 dirhams for each day of delay, while the violation may reach 50,000 dirhams for violating the licensing conditions, in which the speed of responding to claims is an item. Essential to it.

He explained that the system currently used is called “e claim link”, through which all hospitals submit claims to insurance companies, ensuring a quick response if the request information is clear and sufficient, as well as if the hospital admits them early.

He pointed out that some insurance companies follow a special policy, whereby if the value of the insurance claim exceeds 4,000 dirhams, they request special information and documents that may require the hospital to take time to provide, and then the decision on the request is delayed. Other hospitals follow the same mechanism if the value exceeds 1,000 dirhams. .

He pointed out that the Authority received complaints from clients about the delay in deciding on health insurance applications, 90% of which were found to be due to an error in data entry, a lack of documents, or that the employee responsible for insurance claims was not performing his duties fully.

A number of patients complained to “Emirates Al-Youm” that the insurance refused to perform some necessary x-rays and laboratory tests requested by the treating physician. One of the patients who preferred not to publish her name indicated that her husband’s life was at risk due to the lack of a mechanism to accept insurance requests in emergency cases and obtain approval. Instant.

She said that she transferred her husband, who suffers from heart disease, to the emergency department of a hospital, only to be surprised that he could not be treated except in two cases: either by paying a large sum of money beyond her financial ability at that moment, or by waiting until the next day until insurance approval was issued to conduct the required tests. Determine ways to treat him and protect him from any complications.

She wondered about the benefit of health insurance that cannot be relied upon when needed, especially at the time of injuries and sudden serious symptoms, noting that she spent the most difficult hours that night for fear that her husband’s condition would deteriorate or that he would suffer a heart attack while he was at home, explaining that when any patient is exposed In such cases, he feels an additional burden that increases his pain, due to the stress and distress caused by waiting for approvals. He feels that his health and life are hostage to the decisions of insurance companies, which take into account first and foremost their profit interests.

For her part, the patient (S.S.) confirmed that she waited more than a week to obtain the approval of the insurance company to conduct treatment sessions requested by the specialist doctor, to be accompanied by medications to combat severe inflammation that affected the shoulder bones, muscles and ligaments.

She added that she had waited several days until approval was given to perform the required MRI to diagnose the cause of the pain she was experiencing in her shoulder. The patient explained that the time period between her contracting the disease and being able to take the first imaging to determine the cause of the disease took about 10 days due to insurance procedures, until she returned again after being referred to a specialist orthopedic doctor, to wait another week to obtain insurance approval for the doctor’s request, who prescribed physical therapy sessions as one of the necessary and immediate medications. To fight inflammation.

Another patient, who preferred to remain anonymous, said that he suffers from a chronic deficiency in “vitamin D.” He confirmed that the insurance company refused to conduct the blood test required to determine the level of the vitamin to determine the dose required to be taken to compensate for the deficiency and avoid diseases that may result from its deficiency in the body. He pointed out that there are a number of his friends who have suffered from serious and difficult diseases due to vitamin D deficiency, at a time when the insurance company considers the test to detect its level in the blood unnecessary and most of the time tends to reject it or delay approval for its procedure for weeks and months.

Insurance companies refuse vitamin D tests.

Patients – who preferred not to publish their names – said that insurance companies refuse to agree to conduct tests to detect the level of “vitamin D” and dispense medications to compensate for its deficiency in the body, at a time when medical reports and research unanimously agree that “vitamin D” is necessary for bones from childhood until old age. Because it helps the body absorb calcium from food, its deficiency also causes serious diseases, as it may lead to multiple sclerosis (MS), which is an autoimmune disease that damages the nerves. Some studies have also shown a link between low levels of vitamin D deficiency and type 2 diabetes, the most common type of blood sugar disorder. They have also revealed a close link between low levels of vitamin D and an increased risk of heart attacks. , stroke, and heart disease.

Survey: 65% of customers are dissatisfied with insurance services

“Emirates Today” conducted a 24-hour survey on its account on the social media platform “Twitter” after receiving complaints about problems faced by customers of health insurance companies. The survey asked observers whether they were satisfied with the health insurance services provided to them, to which about 65% of the 1,186 respondents responded that they were not satisfied with the insurance services in the health sector. When asked whether their medical problem had increased due to the delay in health insurance approval for them to undergo the required medical examinations, 66% of the 465 participants in answering the question answered in the affirmative, as their answer touches on a number of complaints from patients who confirmed that their medical condition had worsened due to the delay in medical diagnosis. As a result of procrastination in agreeing to conduct the required tests.