I was not surprised to read in this newspaper that an increasing number of doctors in the Kingdom are refusing to accept patients with medical insurance, insisting that they will only treat them if they are paid upfront in cash. Unfortunately, this is a growing phenomenon all over the world, including here in Brazil, which has led to thousands of complaints every year that the Brazilian government has had a hard time keeping up with all of them.

The truth of the matter is that medical insurance companies that provide us with coverage have always been focused more on the profits than on the quality of services provided. Therefore, I was not very surprised to learn from one of my doctors here in Brasilia that a certain insurance company paid him only a certain small amount for each patient that he saw, and advised him to not spend more than 10 minutes with each patient. And you certainly notice that when you see one of these doctors. I remember seeing a cardiologist through my health plan and he sounded so bored as he went through a checklist of questions, all the while not looking at me, that I felt that if I told him I was serial murderer he wouldn’t have blinked and would have continued ticking the boxes on his checklist. Contrast that with my endocrinologist that I pay for from my own pocket to see since she does not accept insurance, and for the equivalent of $133 she talks with me for an hour or more, weighs me, gives me medical advice and prescribes medications.

Like in most rapidly developing countries, many people in the Kingdom who can afford it opt out of government-run healthcare into the private system through the use of health insurance. According to the Council of Cooperative Health Insurance there were 9.6 million people insured in 2014. In Saudi Arabia complaints of medical insurance not being accepted are growing rapidly. The council received 1,600 complaints in 2015, an increase of 56 percent over the previous year. According to the council, 96 percent of these complaints were resolved according to regulatory procedures.

The Ministry of Health can punish doctors who refuse to accept health insurance with fines that can reach SR80,000, while the hospitals that employ them can be fined up to SR100,000.

But even if the government is successful in forcing doctors to accept patients with private health insurance coverage, there are other ways that doctors can slow-down their services in order to discourage patients from using their health plans. In Brazil it is common practice that if you call a doctor and ask for an appointment using your health plan, you will be given an appointment a week or two or three later. Ask the same doctor for an appointment and say you will be paying cash for it, and “miraculously” you will get an appointment for that same day or the day after.

Admittedly, the problem in all of this are not only the reluctant doctors, but the greedy and stingy health insurance companies, who are always looking for ways of saving money and of discouraging their clients from using their insurance too often. Tactics range from taking a long time to approve expensive tests or procedures, or to outright deny coverage for an operation even when your doctor says in writing that you need the procedure for your health to improve. These tactics must work on some people who are averse to fighting for their rights, and who have enough money to pay for the procedures rather than insist that their health plan pay for them. Health insurance executives must count on many of us being pushovers that will not insist or complain when they drag their feet or turn down requests for medical coverage. But we should not give in to such devious and underhanded tactics, when insisting on our rights usually gets what we are entitled to. After all, private insurance is not free and is something that we pay for every month.

In Brazil the regulatory body that oversees medical insurance companies is staffed with ex-executives from these same companies, which is ridiculous as it is akin to putting wolves in charge of the chickens. Hopefully in the Kingdom, the regulators are not populated with ex-medical insurance executives, as this would put the welfare of everyone with health insurance at a disadvantage.

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The writer is a Saudi journalist based in Brazil.