JEDDAH: Treatment requests from health care providers are deemed to have been approved if insurance companies fail to appropriately respond to them within an hour of receipt, officials have warned.
The Saudi Council of Cooperative Health Insurance (CCHI) has urged insured patients to be aware of their rights when receiving medical treatment.
According to the council, it was a breach of its regulations for a health provider to charge an insured patient for treatment prior to having received a reply to an application.
They have already transferred some of such cases to a special committee at the council, the CCHI said.
CCHI spokesman Yasser Al-Marek told Arab News providers that broke the rules would be referred to the relevant authorities within the council.
He added that cases requiring approval included individuals attending an outpatient department where the cost of a single treatment was more than SR500 ($133), those admitted to hospital, and when surgery was required.
Al-Marek pointed out that critical cases did not require prior approval from insurance companies, although healthcare providers should notify insurers within 24 hours. It was the duty of insurance companies to respond to providers’ questions within 30 minutes of receiving them, he added.
Dr. Abdulrahim Gari, the general director and member of the health care committee at the Jeddah Chamber of Commerce and Industry, said insurance companies often delayed approvals by asking for medical tests to be attached to applications when copies were already available to them, and firms employing unqualified staff also slowed the process.
“There should be some kind of accountability process for insurance companies to decide whether the companies have responded and handled the approval request properly and sufficiently. An insurance company may respond within 60 minutes but may not respond with sufficient information and may ask for more documents in an attempt to get around the 60-minute rule,” Qari added.
He pointed out that while the council allowed insurance companies to act as a service provider, it could create conflicts of interest, noting that some insurance companies opened their own hospitals and provided patients with services.
Al-Marek said more information and advice on medical insurance issues was available toll free on 920001177, via www.cchi.gov.sa, by contacting [email protected] or through the CCHI’s social media accounts.
