Saudi Arabia - The Council of Cooperative Health Insurance has confirmed that treating emergency cases no longer requires prior approval from insurance companies, as long as the service provider informs the insurance company within 24 hours of receiving the case.
The council’s spokesperson, Yaser Al-Maarek, urged insured individuals to become familiar with their insurance company’s policy. He also stressed how important it is for them to be aware about the intricacies of the cooperative health insurance system and know their rights.
Fuaad Hawasawi, a health insurance expert, told Arab News: “It’s natural that hospitals are being required to take action now as a service provider. Hospitals are now more in command as they are capable of treating the patient, performing surgeries if needed and after that, they’re required to inform the insurance company of the case within 24 hours. After that, the insurance company can pay the hospital bill and the insured should only pay a specific amount depending on his insurance card, 10 percent of the amount or so.”
He added: “There have been cases before the regulation was passed in which hospitals contacted insurance companies about costly surgeries or a cardiac catheterization case that the hospital deemed as an emergency, but were forced to stop when insurance companies stalled to inquire more and ensure that their policy covered the patient’s case.”
Notably, there are a few treatments exempt from the policy such as cosmetic procedures (except in cases with urgent physical injuries that are not dismissed by insurance policy); injuries caused by self-harm; dental implants or bridges, as well as braces (unless caused by accidents); diseases contracted due to the misuse of certain medications, stimulants and sedatives; and those resulting from use of alcohol and drugs.
The council’s spokesperson, Yaser Al-Maarek, urged insured individuals to become familiar with their insurance company’s policy. He also stressed how important it is for them to be aware about the intricacies of the cooperative health insurance system and know their rights.
Fuaad Hawasawi, a health insurance expert, told Arab News: “It’s natural that hospitals are being required to take action now as a service provider. Hospitals are now more in command as they are capable of treating the patient, performing surgeries if needed and after that, they’re required to inform the insurance company of the case within 24 hours. After that, the insurance company can pay the hospital bill and the insured should only pay a specific amount depending on his insurance card, 10 percent of the amount or so.”
He added: “There have been cases before the regulation was passed in which hospitals contacted insurance companies about costly surgeries or a cardiac catheterization case that the hospital deemed as an emergency, but were forced to stop when insurance companies stalled to inquire more and ensure that their policy covered the patient’s case.”
Notably, there are a few treatments exempt from the policy such as cosmetic procedures (except in cases with urgent physical injuries that are not dismissed by insurance policy); injuries caused by self-harm; dental implants or bridges, as well as braces (unless caused by accidents); diseases contracted due to the misuse of certain medications, stimulants and sedatives; and those resulting from use of alcohol and drugs.
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