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Abu Dhabi, UAEWednesday 20 June 2018

Patients using health cover like credit cards to pay for treament

More education needed on level of health insurance and what treatment is paid for, claim regulators

Some patients benefitting from Dubai’s 2017 mandatory health insurance programme are using their cover "like a credit card" to top up treatments, regulators have said.

Speaking at the Dubai International Health Tourism Forum on Wednesday, Dubai Health Authority’s director of health funding, Dr Haidar Al Yousuf, said patients need to be aware of the extent of their cover and cannot expect to pay for extra treatment with their insurance cards.

“We expect our users to know their rights and obligations when using their health insurance. People must realise that health insurance cannot be used as a credit card,” he said.

He gave an example of a recent case of a woman who had maternity cover with her insurance policy for about Dh14,000.

After her delivery the bill was Dh11,000 so the woman wanted to use the remaining Dh3,000 for extra treatment.

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Some 4.7 million people are now covered under the mandatory insurance programme and Dr Al Yousuf said his department receives relatively few complaints.

“We only get around 200 to 250 complaints a month, or about 3,000 a year from the whole insured population,” he said.

“There is still work to be done, but it is a very small percentage, so we don’t see any worrying trends or major issues.

While most claims are honoured, some patients are still not checking the full extent of their cover before seeking treatment.

The DHA has taken steps to simplify policy details, and has used a minimum font size to avoid confusing small print, as well as printing terms of cover in Arabic and English.

“Declined claims account for less than 10 per cent of the total claims that are paid out to the industry,” said Dr Dennis Sebastian, regional director of the Health Reinsurance Group of America (RGA).

“In the UAE, the total claims paid out every year is about $2.5 billion, but we accept some claims are declined.

“Consumers need to be fully aware of the terms and conditions of their policies. When that doesn’t happen, the negative feeling towards insurers is created.”