Lodge health insurance complaints online, DHA tells residents

Dubai: Dubai residents can lodge complaints related to health insurance online and they will be addressed in three days, a top official has said.

The health funding department at Dubai Health Authority (DHA) will resolve the complaints within two to three days and no longer than four working days in 95 per cent of cases, the official said.

Dr Haidar Al Yousuf, director of health funding at the DHA, told Gulf News: “Dubai residents with legitimate grievances can expect solution when they route their complaints through proper channels. People must come through the iPROMeS website; only then we are able to receive and track complaints.”

 I would like to reassure residents the insurance cover is working very well. Nearly 4.6 million people are now using the cover and millions of transactions take place every year.”

 - Dr. Haider Saeed Al Yousuf, Director of health funding at DHA

Reassuring Dubai residents on their rights, Dr Al Yousuf, who is the architect of the mandatory health insurance scheme, said: “First of all, I would like to reassure residents the insurance cover is working very well. Nearly 4.6 million people are now using the cover and millions of transactions worth billions of dirhams take place every year to cover the population’s health via insurance.”

At the same time, the volume of complaints is not more than 0.01 per cent. “We receive about 200 complaints every month and considering the number of people enjoying the insurance cover, this is a minuscule number and not large at all given the total number of transactions that take place everyday. These are a normal part of the daily life of such a large system, there is no worrying trend or major issues.”

Dr Al Yousuf said all complaints made to the insurance department at the DHA are attended to within two working days. “At the most, we take a maximum of four working days. In some cases, it is a matter of making the resident aware and educating him, in other cases it is the shortsightedness of the health care professional and in cases where the insurance provider is at fault, we summon them and ask them to rectify the error.”

Readers’ complaints

In recent weeks, Gulf News received several complaints from the readers. In one case, a company’s annual group insurance premium went up from Dh42,843 to Dh238,701. Joshy Verghese, the senior accountant of the company told Gulf News: “One of our employees who was diagnosed with cancer had to undergo three cycles of chemotherapy which did not cost more than Dh30,000. But the new quote of the same insurance company for 2018 saw a hike of premiums by 300 per cent.”

In this case, Dr Al Yousuf clarified: “When I tracked this complaint, I realised it never reached the insurance complaint management team. The company representative had not made a direct complaint to us but logged it to the general line of DHA which deals with the organisation as a service provider. I advise people to log in insurance-related complaints on http://ipromes.ecalimlink.ae.”

He further added: “We are looking into this case but, very broadly, we can tell you no insurance company can hike the premium by 300 per cent. The company will receive a revised quote from the insurance provider and we are handling the case.”

In another case, a reader registered a complaint about how on two occasions a health clinic had rejected her medicine claims which were approved within 15 minutes when she directly called the insurance company. The reader further complained how her physiotherapy request was rejected by the insurance company and a reimbursement claim of Dh1,800 has been delayed.

Dr Al Yousuf once again reiterated: “Very often, residents have a legitimate complaint, but on some occasions there is confusion regarding what is covered and what is not. In case of emergency, none of the procedures need prior approval. So if it is a CT scan or an X-ray during emergency, there is no waiting. In cases where the procedure is elective, the maximum delay in approvals is 48 hours. For medicines, it is an online portal where pharmacists get approval within two minutes.”

Dr Al Yousuf further clarified that the DHA is very keen to educate the residents to make them aware of their rights and they also summon insurance providers or health care providers when there is a legitimate complaint in the processing of the claim. “In the end, it’s our duty to ensure that the rights of the insured people are protected.”