Medical Insurance Q & A - Saudi Arabia

Selected Medical and Health Insurance Q & A - Saudi Arabia

Published by Saudi Gazette, English Newspaper, Jeddah, Kingdom of Saudi Arabia

By Shujaath Ahmed Khan, General Manager, Creative Associates, is also a free lance writer and Insurance Columnist for Saudi Gazette.

Q: I am a medical doctor working for a clinic. I have been working with around 13 to 18 insurers and always feel frustrated as some claims get rejected by some insurers while others accept them. It is very difficult to understand which insurer is covering what. Certain policies are clear but most of them are confusing. How can we cope with such situations?

A: Your experience is quite understandable. But the entire blame cannot be shifted to the insurance company. In the over-all insurance sector, there is a lack of well-qualified and trained personnel. Some insurance claims handlers may not be well conversant with the conditions of the policy. The policies are also drafted in such a way that gives some scope for confusion. The recent drafting of policies by CCHI has provided some sort of uniformity to the standard coverage. But it also has certain grey areas, which are being interpreted differently. I will suggest you to put the diagnosis and prognosis clearly on your prescription slip. This will help the doctors processing your claims to relate the prescription with the drugs, tests and other procedures and reduce the number of rejections. You can always re-submit the rejected claims with your comments and explanation. If you feel that the claims are rejected unjustifiably then you have a right to lodge a complaint and even stop dealing with the concerned insurance companies.

Q: I am a doctor working for a reputed hospital. Since the very beginning I was interested in health insurance management and policies. With the recent boom of medical insurance I want to make a career in medical insurance. Kindly let me know of any courses for doctors to get trained for specific management positions in insurance industry?

A: Medical Insurance is a vast area. It offers tremendous opportunities for job seekers. Even today there are variety of policies, which will help us in better understanding of medical insurance.We are progressing toward regulated medical insurance products, which will be simpler and easier to understand.Since you are working for a reputed hospital in the Eastern Province, it must be having various personnel authorized to deal with insurance companies. I will suggest you to try to enter that area and gain some experience in insurance claims handling. Simultaneously, you can appear for professional insurance examinations. Nowadays these are conducted twice a year.To start with you can appear for licenciate examination, which will be held in the later part of this year. You may visit the website of Insurance Institute of India.Once you gain some experience you may look for opportunities with medical insurance companies and/or Third Party Administrators.

Q: I am working for a multinational company. We are having full medical insurance. My wife and children are also covered under the policy. I am planning to bring in my mother-in-law for Haj. She will be staying here for at least three months. Our insurance company informed us that they cannot provide cover to her. How can we get her covered for medical expenses?

A: Most of the insurance companies do not cover parents or people other than the wife and children of members. There is also a restriction in getting the coverage for visitors. However, there are other options but these are a bit expensive and will not give adequate coverage. The best option available to you will be to check with insurers in her home country. They will have medical coverage under their specific policies to cater to overseas travelers.The title of the coverage may differ like overseas health insurance, overseas medical insurance or overseas medi-claim, international, visitors etc. It is cheaper and you can get adequate coverage.Other option available to you is to buy standard travel insurance with adequate medical coverage. There are different packages available depending on the sum insured and the length of stay. Plan her stay first and then try to buy the cover for her accordingly.