10) Last month coverage:
There are instances when insurance policy holder is denied coverage in the last month – such as medicine coverage in the month of December even though the coverage is up to end of that month. This is illegal according to the UAE law.
“If any pharmacy or clinic is doing that, it was illegal,” says Dr Al Yousuf. “The clinic must provide the insurance cover until the last day of the health coverage and insurance policy holders have a right to register a complaint if there is a violation of this right.”
Residents can register complaints on http://ipromes.eclaimlink.ae which is usually attended to within 48 hours of the receipt of the application.(GN)
Limit to visit a doctor
There is a limit to the number of times a patient can visit a doctor for a single episode. Let’s say when a patient discovers he has a fever, or any ailment where he consults a physician at the clinic, he can visit the same doctor for the same episode usually three times within 10 days for the same ailment. So on day one he goes for the first consultation, day three he might report for a follow-up and day six or seven he might want to reconsult to chart his recovery. He will be charged one time consultation fee for this. Once this limit has been reached, further approval from the insurance company must be sought.
Pre-approval for a medical procedure
Reality: Approval is only valid for a limited period of time. The exact period of validity should be communicated clearly to the patient. If the patient does not have the treatment within the specified time period, he or she may need to reapply for approval. Besides, patients must know that approvals for tests and procedures take time. For example, if a patient is prescribed tests worth Dh1,500 and his insurance provides cover for only an amount up to Dh1,000, both the patient and the doctor must wait for approval unless it is an emergency.
Only in the case of an emergency should the patient receive treatment for their immediate needs. The hospital or clinic should try to get a response from the insurance company as quickly as possible.
How well are you covered?
Insurance companies may not cover all tests, (for instance tests like Vitamin D tests and screening for HIV or Hepatitis B and C are not covered usually and you need to check your insurance policy plan. A lot depends on the kind of insurance policy the patient has signed up for. Most don’t cover opthalmology and dental treatments and this should be communicated clearly to the patient.
Ambulance services
Reality: Ambulance service is only covered if there is an emergency. The insurance company should ensure that the patient understands this.
Call up the insurance company and check the coverage of prescribed procedure
Doctors do not always know which conditions are covered by a specific insurance policy, so it can be difficult for doctors to prescribe treatments or procedures. The best thing a patient can do is to get their clinic or hospital to call up the insurance company and check against the coverage if the prescribed procedure will be covered.