Medical insurance claims in UAE hospitals: Is it a smooth experience now?
UAE is bringing in compulsory medical coverage across all emirates from January 1
Dubai: There has been a marked improvement in insurers releasing funds to hospitals and other healthcare providers in the UAE as part of the claims related to treating patients, say industry sources.
If this is the situation, this would further smoothen the way for the health insurance sector in the UAE, more so as the UAE is bringing in compulsory medical coverage across all emirates from January 1. Until now, only Abu Dhabi and Dubai had such a mandate in place.
While the overall size of the health insurance market goes up immediately after January 1, there is a fine balance hospitals, health insurers, and third-party administrators (TPAs) will need to maintain. Only then can there be a smooth experience for UAE residents when they are in need of medical support. (TPA are entities that act as the go-between between insurers and healthcare operators in processing claims, getting insurers to release the funds, and then pay off the hospitals.)
At the same time, hospitals need to see timely release of funds the insurers on the costs to treat patients. Any delays on that front creates cash flow crunch for healthcare operators, and creating a situation that’s been needing a cure for some time.
Industry sources say there have been marked improvements this year.
“At the beginning of this year, a framework was introduced requiring insurers to make direct payments to medical providers within some emirates,” said Daniel Whitehead, the newly appointed Middle East and North Africa CEO of MedNet Group, one of the bigger health insurance providers.
“While this led to some initial challenges, the situation is steadily improving.
“As a TPA, MedNet plays a facilitative role between insurers and providers in respect of payments to both healthcare providers and individuals.
“The process is complex, and usually works very well. However, all parties face challenges from time to time and in particular when new workflows are introduced.
“We are observing positive trends toward faster, more streamlined payments as the system matures.”
Hospital operators confirm that there has been a speeding up of medical claims, more so after the UAE authorities had their say in the matter.
"The DHIC (Dubai Health Insurance Corp.) has brought in more controls, compliance and transparency in the entire health insurance claim process," said Singaram Annamalai, CFO of Prime Healthcare Group. "This has has positively impacted the turn around time of 'claim to collection'.
"To further improve, effective January 1, 2024, the DHIC introduced a system wherein insurers were asked to pay the medical provider directly, which has further improved the payment cycle resulting in better cash flow management in addition to safeguarding the medical provider’s interest."
What happens after January 1, 2025?
All private sector employees (and domestic workers) in the UAE have to be under medical coverage from January onwards. For private sector employers in the northern emirates, this is another cost that they will need to account for.
“The UAE government had provided advance notice a good two years ago that mandatory health insurance was coming in,” said an official with a leading local insurance firm. “Most employers would have already prepared for it and worked on finalizing the annual employee group coverage policies with insurers.”
Apart from residents, who now find they are having medical insurance cover, the UAE’s overall healthcare industry benefits from now having a much larger resident base to provide quality – and even affordable – treatment.
A lot is happening in GCC healthcare
Changes in the medial insurance space are happening across GCC states, where private sector healthcare providers now take on more of the responsibilities to provide consistent services.
“The healthcare insurance landscape across the GCC markets varies in maturity and competitiveness,” said Whitehead. “For instance, Saudi Arabia is currently dominated by a few key insurers who primarily manage claims in-house.
“However, the region presents significant opportunities for growth, as more markets move toward mandatory health insurance coverage. The demand for safe and effective healthcare solutions for insured members plus advanced and efficient claims management capabilities is rising. TPAs like MedNet are well-positioned to support this shift.”