Dubai Health Authority revealed that the rejection of treatment coverage by insurance companies is the most important complaints that they monitor and deal with, and the authority confirmed that it is working to develop and update health insurance packages in the emirate continuously as needed.

The executive director of the Dubai Health Insurance Corporation of the authority, Saleh Abdul Ghaffar Al Hashemi, told «Emirates Today» that the insurance coverage in Dubai has so far covered 99% of the residents, and stressed that the process of reviewing and improving the health insurance packages remains ongoing where needed, indicating that the authority She finally entered the examination and coverage of hepatitis C, in addition to three types of cancer within the insurance coverage, in line with the community’s need, and in the interest of patients. He added that the majority of the complaints of the auditors with the health insurance companies in Dubai focused their reasons on the insurance companies' refusal to cover the treatment, and the main reason for this is the failure to mention the presence of symptoms and illness in advance at the time of buying the insurance.

He clarified that the complaints of the auditors about the delay in deciding on health insurance requests, that 90% of them were due to an error in entering data, or a lack of documents, or that the employee responsible for insurance claims is not fully functional.

Al-Hashemi stressed that the current insurance system was designed to ensure the completion of approvals for health insurance requests within seconds of entering the application, while the delay in deciding the applications results either from a failure to enter the application data or the company’s need for more information.

He pointed out that the unjustified delay of insurance companies in responding to claims is considered a violation of the law, and the company is subjected to a financial fine of 1,000 dirhams for each day of delay, and the violation may reach 50 thousand dirhams to violate the terms of the license, which is the speed of responding to the claims is an essential clause .

He added: “The Authority deals with the exaggeration of doctors and health centers in imposing medical tests and analyzes for simple health symptoms, with the aim of draining health insurance according to a specific mechanism, whereby the claims company follows the benefits and policy of insurance programs imposed by the authority according to the schedule of benefits, and accordingly the claims company Accept or reject claims based on the medical diagnosis sent by the service provider.

Response speed

Dubai Health Authority revealed that the system currently being used is called the "e claim link", through which all hospitals submit claims to insurance companies; ensuring the speed of response in the event that the request information is clear and sufficient, as well as if the hospital entered it early.

1000

AED fine for every unjustified delay from insurance companies in responding to claims.