Insurance pre-approvals causing huge delays for patients in the UAE
Average time spent during a visit to the hospital or clinic is 79 minutes, study reveals
Dubai: All of 79 minutes — that is the average time spent by a patient at a hospital or a clinic in the UAE during a visit these days. Now, here’s the bitter pill — nine minutes is all that he or she actually gets with a doctor for the check-up procedures.
The rest of the time is taken up clearing the formalities leading up to the point where the patient meets the doctor. These steps are taking longer and longer, as health care operators work with medical insurers to find out what sort of care the patient is entitled to and how much it should cost.
The 79 minutes only cover the point from the patient’s entry into the hospital and clinic to paying his or her share of the bill. It does not take into account the trip to the pharmacy to collect medicines.
In the past a patient could come directly and seek the consultant. It’s not that easy any more — everything is being duplicated in a way.
Making these revelations, Jobilal Vavachan, CEO and Vice-president at the Aster group, said, “These are based on a study we did internally last year and I believe the time spent has shot up quite dramatically during this period. In 2016 or 2017, the average time would have been around 45 minutes.”
Other hospital networks in the UAE Gulf News spoke to also said it is taking longer for patients now to seek advice for their ailments. Even specialist clinics are burdened by the longer tenure of these visits.
Health care providers are unanimous in what’s causing the clogging — the time they spend “taking pre-approvals” from insurers for each step in the treatment process. So, if a patient walks in to see a specialist, hospitals/clinics insist on them first being checked by a general physician and only then being passed on to the specialist, if necessary.
As the market consolidates and fewer insurers work more professionally with fewer health care providers, the situation will ease.
“In the past a patient could come directly and seek the consultant,” said Vavachan. “It’s not that easy any more — everything is being duplicated in a way.
“An eligibility check needs to be performed before the consultation. We have to take approval from the insurer before doing any procedure. Insurers too have lost a lot of money in the last one year or so on their medical policies, especially those administering low-end health insurance. They have in turn put the pressure on hospital operators on each procedure involved in the treatment ... With approvals taking time, the person who suffers is the end-user. He has to wait for an approval right from consultation and lab test to getting the medicines.”
So, what has led to this point?
Industry sources say this is the natural outcome of medical cover becoming compulsory in Dubai and Abu Dhabi. In Dubai, first two years after this came about saw newly insured residents making a beeline to hospitals and clinics. Their belief was that insurance would take care of everything … but not for too long.
By 2017, insurers realised that their medical lines were starting to hurt them, and in 2018, they were starting to bleed financially. After two record years of issuing policies and collecting premiums, they were hit with a stark reality.
There is no doubt that costs of treatment have risen while premiums are at their lowest or stagnant.
In a difficult economy, employers were forced to drive hard bargains with insurers in ensuring coverage for their employees. Group policy benefits were often cut across the board so that premium costs could be brought down.
Then again, the premiums insurers set were too low to sustain their businesses in the longer term. They started to enforce upper limits on what their policies could provide; so someone with a EBP (Essential Benefits Plan) that costs Dh600 a year can only access medicines totalling up Dh1,500-Dh2,000 a year. An individual on a low-end coverage can access up to Dh5,000 worth of prescribed medicines a year.
Mark Adams, CEO of The Healthcare Network, suggests that tough decisions need to be made, and fast.
“As the market consolidates and fewer insurers work more professionally with fewer health care providers, the situation will ease,” he said. “Capitation” is one solution which is used in Dubai today, but not allowed in Abu Dhabi.
“If clinics are paid a fixed amount per month per patient to cover all consultations, minor treatment and diagnostics, the clinic has no incentive to over treat. Indeed, there is likely to be a move to more preventive treatments and therapies.
Adams said, “Where clinics can show conservative approaches to treatment and prescribing, it is possible to agree on improved terms with insurers that could include payments-on-account. This would, however, require very different relationships that tend to exist today.” (Payments on account are essentially those made in advance before the set deadline.)
Has market dynamic reached a point where health care providers and insurers need to come up with a set of solutions before it reaches breaking point? Or is it something for health care authorities to intervene and enforce?
According to Anil Nair, CEO of Iris Health Services, “This is not only a payer’s issue — Insurance companies, TPAs (third-party administrators) and medical service providers each have to take steps to improve clarity, accuracy and efficiency to eliminate the strain in the system. While medical service providers, for example, need to submit complete claims information to the payers on time, payers also need to revert with timely responses to providers.
“There is no doubt that costs of treatment have risen while premiums are at their lowest or stagnant. Abu Dhabi, for example, has increased the premium for enhanced EBP (Essential Benefits Plan). There is an urgent need for an increase in premiums to ensure proper coverage, better community health, and the sustainability of the health insurance sector.”
That the UAE’s health insurance sector could do with a cure is something everyone agrees on. It’s the prescription that they are waiting for.
What are residents saying?
Shereen Dury, 46, from Fiji
“In an age when everything is digitally processed and stored, I don’t understand why health insurance providers require us to fill out complicated forms every time we apply for a payment. After all, they must already have access to these details. I have a health insurance plan that provides some dental coverage. But in order to avail of it, I have to submit a form that has to be filled by both me and the health care facility. The process is so cumbersome that I’ve put off getting dental work done for nearly eight months now. In my opinion, the health insurance industry is really lagging when it comes to automation and customer convenience.”
Habib Bacha, 41, from Lebanon
“I have never been one to go to the doctor very often, as I prefer natural remedies as much as possible. But my wife does see doctors often enough, and I can say that we have not had trouble with insurance-related processes. In fact, my wife delivered in Lebanon in 2009, and I remember that we had to get insurance pre-approval at the time. The whole thing only took two days. I’ve had the same health insurance for nearly a decade, with local and international coverage, and the package costs about Dh20,000 a year.”
Mohiddin, 38, from Bangladesh
“I am worker in Sonapur. My usual complaint is gastric trouble and acidity. Oily food, long working hours and living away from family are contributing to digestion issues. Stomach upsets are a common complaint in all my colleagues. The pharmacy refuses to give us medicines that are priced above Dh20. Often I have had to wait for 30 minutes at the pharmacy to get clearance and approval for the most basic medicines and I have to shell out money from my own pocket.”
Nisar Ahmad, 44, from Pakistan
“I am a plumbing foreman. I had severe urinary infection, backache, fever, and the doctor at our clinic in Sonapur asked me to undergo laboratory tests. I needed an antibiotic and pain killers. The GP prescribed medicines which cost Dh100. After waiting for 25 minutes the pharmacy salesman who was trying to get approval was told by the insurance firm that only when the lab reports come out can the medicines be given. My GP said I needed to take them immediately for relief and antibiotics would prevent the infection from getting worse. I spent nearly three hours from clinic to pharmacy and back to clinic in pain, but was not given the medication. The only choice I had was to buy the medicine at my own cost. This was not the first time I have had approval trouble.”
(Interview by Suchitra Bajpai Chaudhary, Senior Reporter and Samihah Zaman, Staff Reporter)