General Information

The Rights of Patients & Categories where prior approval required from Insurance Cos. in KSA

Saudi Arabia has provided its citizens and expatriates with insurance policies that allow people to avail health facilities without the thought of paying quickly. Not only did the local citizens but the foreigners such as Saudi tourists and Umrah & Hajj pilgrims have to go medical insurance compulsory.

Under medical insurance, several insurance companies will pay their hospital and medical dues under certain conditions. There’s an official contract between the insurance companies and the different hospitals from where the insurance holders can avail discounts.

However, at places, the hospital authorities, as well as the insurance companies, delay their procedures intentionally causing the patients to pay from their pocket even though they are liable to insurance. To aware patients about their rights and regulate the insurance working, Saudi Council of Cooperative Health Insurance (CCHI) has passed a new order. What is it about? What are the rights and working of insurance companies? Read all about it in the article below.

The need for application approval and payment of dues

According to Saudi Council of Cooperative Health Insurance (CCHI), the patients must be aware of their rights while receiving medical treatments and warned the service providers that if the insurance companies fail to respond within an hour of application, it must be considered approved rather than asking the patient to pay for the treatment. Read more: Health Insurance cards no more required soon after linking to National ID or Saudi Iqama

What cases would be referred to the council of CCHI?

If the service providers were found breaching the law and asking for payments from patients for the treatment before insurance application approval, strict action would be taken against them. Several such cases have been referred to CCHI special committee at the council. According to the spokesperson of CCHI,

Providers that broke the rules would be referred to the relevant authorities within the council.

Which cases require prior approval before treatments?

According to CCHI, following cases require prior approval.

  • Individuals attending an outpatient department where the cost of a single treatment is more than SR.500 or $133.
  • Those admitted to hospital.
  • Where surgery is required.

Which cases don’t require any approval for treatments?

The spokesperson of CCHI told the media that critical cases did not require prior approval from insurance companies, he further said,

Although healthcare providers should notify insurers within 24 hours. It was the duty of insurance companies to respond to providers’ questions within 30 minutes of receiving them.

The intentional delaying of insurance companies hindered patient facilities

The Saudi authorities share their observations that the insurance companies intentionally delayed approval with lame excuses such as the need of attaching medical tests. However, they have copies with them already, or firms are employing unqualified staff. He further added,

There should be some accountability process for insurance companies to decide whether the companies have responded and handled the approval request properly and sufficiently. An insurance company may respond within 60 minutes but may not respond with sufficient information and may ask for more documents in an attempt to get around the 60-minute rule.

Why Saudi Authorities think that insurance companies should not be service providers?

The Saudi authorities believes that by allowing insurance companies to be a service provider, it could create conflicts of interest, as some insurance companies have opened their hospitals and provided patients with services. Read more: Health Insurance is compulsory for Hajj and Umrah pilgrims

How to gather more information regarding patient’s rights?

For more information and advice on medical insurance issues, you can call on their toll-free number, 920001177, or ask them via, or contact them at [email protected] or through the CCHI’s social media accounts.

It is very important to understand your rights so you can stand by them and get them. Spread the article in your circle so the maximum can understand what their rights are and what the insurance policies are liable to perform. The inability to know our rights give an edge to the authorities to enjoy their status and loot patients.

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Source: Arab News

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