Health sys­tems’ com­plaints com­mis­sioner presents re­port against in­sur­ers

The Jerusalem Post - - NEWS - • By JUDY SIEGEL

More than a fifth of the com­plaints filed by pa­tients against the four pub­lic health in­sur­ance or­ga­ni­za­tions over their pro­vi­sion of ser­vices have been found by the Health Sys­tem Om­buds­man’s Of­fice to have been jus­ti­fied.

An ad­di­tional 19.5% of the com­plaints were re­solved by the om­buds­man’s of­fice, and 21 of the com­plainants re­ceived help­ful in­for­ma­tion and re­fer­rals for help.

The re­port, is­sued on Tues­day and due to be pre­sented to the Knes­set Speaker’s of­fice, cov­ered 16,361 re­quests for help, in­clud­ing 8,402 com­plaints that in­volved prob­lems in trans­fer­ring to a dif­fer­ent health fund, get­ting retroac­tive pay­ments for med­i­cal ser­vices that had been re­fused and other is­sues.

The om­buds­man (pub­lic com­plaints com­mis­sioner) re­ported that Clalit Health Ser­vices, the largest in­surer, in­curred the low­est rate of com­plaints, fol­lowed by the sec­ond largest, Mac­cabi Health Ser­vices. The high­est rate of com­plaints was re­ceived against the small­est health fund, Leu­mit Health Ser­vices, fol­lowed by Meuhedet Health Ser­vices, the third largest in­surer.

About half of all the com­plaints were about the bas­ket of health ser­vices sup­plied by the in­sur­ers, fol­lowed by ad­min­is­tra­tive deal­ings with pa­tients, choice of the provider of med­i­cal ser­vices, emer­gency ser­vices, sup­ple­men­tary health in­sur­ances, pro­fes­sional treat­ment and in­for­ma­tion.

A Leu­mit spokesman said that while it had re­ceived the high­est rate of com­plaints, it also had the largest num­ber of com­plaints that were fi­nally re­solved and the small­est num­ber of jus­ti­fied com­plaints.

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