INSURANCE APPROVAL DELAYS AFFECTING HOSPITALS

Patients are increasingly being pointed towards second opinions and cheaper treatments abroad

Delays to health insurance approvals for high-risk operations are forcing some patients overseas for medical procedures, hospitals say.

A culture of overspending and waste in health care has led insurers to become more cautious and patients are feeling the pinch.

Hospitals have reported more insurers requiring a second opinion or cheaper alternatives overseas, with industry insiders warning the trend could halt market growth.

Delays of up to six months have been reported, resulting in missed appointments with visiting doctors who usually have tight schedules on shortterm UAE visits.

“We find delays in approvals particularly when it is for a high-cost surgery with most insurance companies,” said Dr Sharmila Jadav, a GP who is deputy director of insurance at Zulekha Hospital.

“Insurers often ask for a second opinion before the surgery is approved, and at times they want to send the patient to their home country for the procedure as it is more cost effective, even when they consider the cost of travel and accommodation for the patient and their family.”

Patients have been forced to find treatment in Thailand, Malaysia, India and Africa as insurers failed to sign approvals in time for a visiting doctor, or rejected the claim outright.

“Generally, insurers try to do this with cases that are not high risk but even then a longer turnaround time can be stressful for patients,” Dr Jadav said.

“It causes problems as the patient is already unwell, so any delays in getting the required treatment can prolong their discomfort and add to their stress.

“This can worsen a patient’s condition. Sending patients home for surgery is not helping the plans to make Dubai a destination for medical tourism, as it is having the reverse effect. Cost is a major consideration now for insurers.”

In 2016, Anglo Arabian Healthcare warned an oversupply of beds and systematic financial abuse threatened the futures of some care providers, with bed supply forecast to outstrip demand by up to 600,000 a year by 2021.

A focus on the most expensive health centres could also lead to a shortage of beds for low-income workers on basic insurance plans, the healthcare provider warned.

A data-sharing scheme launched by Dubai Health Authority in 2016 is helping to cut fraudulent claims and insurers are more careful about approving expensive operations with the best visiting doctors.

Coronary bypass procedures and laparoscopic surgeries are the most common treatments for which insurers seek a second opinion.

Iyyappen Kolappan, an insurance manager at Saudi German Hospital in Al Barsha, said delays were not uncommon but usually resolved quickly.

“Sometimes, insurers want a second medical opinion before they will agree to a procedure and we have had some issues in this area,” Mr Kolappan said. “Most hospitals are experiencing similar problems.

“The maximum for approvals that we experience are just 48 hours for most procedures, but it can be longer for more expensive or more complicated surgeries.

“They can take around seven days to get approvals, which can have an impact in patients.”

One Dubai resident took out a Dh20,000 diamond insurance plan with a national provider offering maximum coverage internationally for his wife and two children.

His wife was diagnosed with fibroids, non-cancerous growths around the womb, and needed urgent surgery.

Costs were estimated at Dh36,000 but the appropriate visiting doctor, who was one of

Cost is a major consideration now for insurers DR SHARMILA JADAV Deputy director of insurance at Zulekha Hospital

the best available in the field, was only in the UAE for a week.

The family were told to wait six months before any operation could be carried out under the insurance plan, with no reason given for the delay.

Six months later, after follow-up appointments, the patient was told the surgery was not covered by the policy as it was an existing condition.

“Insurers are being more cautious about offering approvals, as people in the UAE have got used to the health insurance model and have become used to seeking a second opinion,” said Stephen Maclaren, an Al Futtaim Willis Insurance Broker. “It can take months to get a second opinion.”

In 2017, the Health Authority Abu Dhabbi introduced reforms to clamp down on patients referring themselves to costly specialists, with adults asked to get a doctor’s referral to ensure a better diagnosis.

Adult patients aged 18 to 60 seeking a second or subsequent outpatient appointment for the same specialty within 21 days, without a doctor’s referral, will only be covered if the patient obtains approval.

“Patients rely on hospitals and clinics being capable of using the system efficiently,” Mr Maclaren said.

“Patients get annoyed with insurers for not paying, but they don’t always realise that visiting doctors charge more for their services.

“It’s easy to blame the insurers but in my experience, visiting doctors are usually at the top of their field and are nearly always more expensive to use.”

Dubai Health Authority had no comment.