Health insurers ‘must respond within an hour’

Health insurers ‘must respond within an hour’
Updated 17 December 2015

Health insurers ‘must respond within an hour’

Health insurers ‘must respond within an hour’

JEDDAH: Health insurers have been ordered to respond in no more than 60 minutes to patient requests for treatment in hospitals.
If there is any delay, then the patients can file complaints about services provided, the Council of Cooperative Health Insurance (CCHI) said on Tuesday.
Messages about the new order have been sent by SMS to all health insurance policyholders. 

CCHI also informed the public via SMS about the policy. "If the insurance company did not respond to the approval request within 60 minutes, that would be (considered) a consent," the message went.

The policy applies to cases in which hospitals need approval from health insurance providers. When a patient seeks treatment at a hospital for a particular ailment that needs approval from the insurance provider, the hospital contacts the provider for approval. According to the CCHI, if the provider fails to respond within 60 minutes, the hospital can proceed with the treatment requested and charge the insurer with the cost. Should the insurance provider refuse to compensate the hospital, the patient can file a complaint with the CCHI.

CCHI said that patients can file complaints free of charge on 920001177 or on the fax number 0114870071, or online at www.cchi.gov.sa. The CCHI has urged insurers to provide the best possible services to their policyholders.

The CCHI was set up by the government in 1999 to regulate the health insurance industry. The body is entrusted with drawing up relevant draft legislation that would ensure insurers provide adequate medical coverage for policyholders and their families, with costs determined on actuarial calculations.
The body must determine which organizations are qualified to operate in the market, and pricing of health insurance policies after consultations with the Ministry of Finance, according to information on its website.
The CCHI is chaired by the minister of health with representatives from the ministries of health, labor, finance and commerce. There are also representatives from the country’s various chambers of commerce and the private health sector.