Health insurance firms owe hospitals in the Kingdom SR 2 billion in unpaid claims a health official said here recently.

This was out of a total of SR 6 billion in health insurance claims in Saudi Arabia in 2012, said Sami Al-Abdulkarim, a member of the Council of Cooperative Health Insurance (CCHI) and head of the national health committee at the Council of Saudi Chambers (CSC).

He said that some insurance companies were acting unprofessionally with health service providers by stalling the payment of their financial dues and delaying making decisions concerning their claims. They want to pressure health care providers to accept unfair settlements, said Al-Abdulkarim.

He said there was a problem of trust between health care providers and insurance companies. The insurance companies often question medical reports sent in by hospitals and then delay payment.

He said these firms are not deterred in any way from continuing with their "violations and manipulations." He added that it was the duty of the Saudi Monetary Agency to take action because it licensed these firms to operate in the local insurance market. The CCHI's role is to develop and improve relations between the three parties: insurance companies, health care providers and clients.

Muhammad Mutabbaqani, deputy chairman of the national health committee at the CSC, said insurance companies have not paid “many hospitals’ claims and have also made additional deductions on bills.” He said the legislation governing the work of the CCHI regulates the relations between all parties but these regulations have to be implemented with fines.

Abdulaziz Abussoud, a member of the health committee, said there has been an increase in unpaid claims because of the rising demand for insurance products in Saudi Arabia; and because government forced these companies to provide two products — medical and car insurance — which are the most income-generating products.

He said health care providers — hospitals, clinics, pharmacies, laboratories, physical and radiotherapy centers — provide the service first and then claim the treatment costs within 90 days. An insurance company should pay a claim within 60 days of the date it is received.

The dues are considered delayed (unpaid) only if they were not paid within the 90-day period. After that the health service provider can stop providing the service and complain to the CCHI. Some health service providers even stop dealing with the insurance company, he said.