When Viki D'Cunha's insurance company refused to cover the medical expenses for his rare eye disease that needed urgent surgery, he argued, fumed and fretted but ended up paying from his pocket despite having a comprehensive medical cover given by his employer.
Earlier this week, results from a well-being survey done in the UAE in December 2016 showed that nearly half of the respondents (45 per cent) are not fully covered by insurance and have to pay for their own medical expenses.
The 2017 Cigna 360 Well-Being Annual Global Survey's findings showed that close to 50 per cent of the UAE respondents are concerned that they will be unable to pay for their family's or own medical expenses, above their mandatory employee coverage.
Read: 45% pay own medical bills in UAE: Survey
For Viki, 31, there was no choice but to pay from his pocket else he would have lost his eye sight gradually.
In December 2016, Viki was diagnosed with keratoconus, a non-inflammatory eye condition in which the normally round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This results in significant visual impairment over time.
"When my doctor recommended lasik surgery, I naturally assumed my insurance company would cover, but they refused quoting a clause saying that it was to improve my eyesight," Viki told Khaleej Times.
"So I got in touch with Dubai Health Authority (DHA) and the company gave the same reply to them as well. My only concern is that it was a condition that should have been covered since it is a disease," he said.
Viki finally got the surgery done on one eye in Mumbai, India, and paid approximately Dh2,000. "If I had it done in the UAE, it would have cost me Dh8,000 for each eye," he said.
"I can luckily afford it but there are many who cannot, especially if they have to keep paying out of their own pockets," he added.
An insurance company official said on condition of anonymity that some medical conditions are standard exclusions in insurance.
These include medical issues at birth, issues caused by medical procedures or research work, radiation, nicotine addiction, sex transformation, as well as hormone therapies, among others.
"The medical condition has to be declared and if the insured has the above conditions, the coverage will be limited," he said. Though some cases are covered, the premiums remain high and variable, depending on the condition and the follow-ups required.
According to the survey results, the UAE ranked fifth in the total 13 countries that were surveyed with a health score of 63.1 amongst an average of 62.3.
The survey also indicates gaps in workplace health insurance benefits, with 45 per cent respondents saying they pay out of their pocket for medical expenses, compared to 37 per cent who said their employer-provided insurance covered their medical expenses. Family health scored the top in the UAE standing at 65.8 while financial health was lowest at 53.1.
"Our learning from the survey indicates many people are unprepared for their future healthcare costs," said Jason Sadler, president of Cigna International Markets.
With the rising incidence of chronic illness in Dubai, where 30 per cent of deaths are caused by heart disease, there is clearly a need for a greater focus on wellness.
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