| 31 Jul 2010 |
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Time factor crucial for health card holders
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It's always such a big relief to have health coverage, but, failing to know the basics of your insurance plan and relying solely on your physician's advice, especially concerning laboratory tests, could burn a hole in your pocket.
This was experienced recently by an NAS card-holder at a Dubai branch of a large private hospital.
A Pakistani national, Mohammed, was undergoing treatment at the private hospital for electrolyte imbalance. In May this year, his doctor prescribed him a new set of medicines, but in order to check his body's reaction to the drugs, the nephrologist asked for a series of blood tests -- the first after three days of taking the medicines, and three days thereafter.
As the first result was good, the 60-year old was verbally told by his doctor not to do the follow-up test after three days, and was told to get it done after three weeks -- without changing the date on the lab approval form.
When Mohammed went for his second blood test on June 10, he was asked to pay Dh50. He refused as he thought the test should be covered by his insurance. He was told that his lab approval was 'outdated' and that 'all tests should be done within a week of consultation with the doctor.'
"I asked him to call the doctor to change the date. I even said I would come back tomorrow and get the date changed and stamped by the doctor but he said, 'it will not be valid, even if the doctor changed the date it will not be valid... all tests should be done within a week'," said Mohammed.
Sheja, an insurance officer at the hospital, told Khaleej Times that as per the standard policy, follow-up visits and lab tests should be done within seven days after consulting a physician. And since Mohammed's visit lapsed the seven-day grace period, he should pay for the blood test.
"If the test was not done within the validity period, we have to ask for re-approval to extend the date," following a recommendation from the physician, she said. However, in this case the doctor failed to send the request for re-approval. Speaking to his doctor thereafter about the problem, the patient was told emphatically that, "as a doctor, my only concern is the well-being of the patient... this is between you and the insurance company. It has nothing to do with me."
A claims representative of NAS has also confirmed the company's standard protocol for lab tests to be done within seven days after consultation. However, this could be extended provided the physician writes his recommendation in the lab approval form.
"The doctor needs to write it down, otherwise, there will be problem in claiming the payment," he said.
By Olivia Olarte
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