NHIF threatens to deregister hospitals that reject patients
Kenya’s national health insurer yesterday warned its contracted hospitals against turning away patients because of fears of bill defaults.
While confirming that many hospitals were not serving patients for fears that it may not foot their bills, the National Hospital Insurance Fund (NHIF) warned that such health facilities risked being delisted for breach of contract.
Speaking during a public forum bringing together community leaders from the informal settlements and small scale traders in Buru Buru, Nairobi, NHIF officials explained that hospitals that were turning away patients were not happy with the new claims verification measures.
“The issue where patients are being turned away from NHIF contracted hospitals, is something that is happening daily, but the facilities that are doing this are contravening the contractual agreement with the NHIF,” said Mary Nyachae, NHIF Nairobi regional manager.
Premiums
She issued the warning ahead of this morning’s flagging of a nationwide roadshow to sensitise Kenyans about membership.
“NHIF is not broke as widely reported, and the issue is not related with what’s happening on the ground.”
Nyachae said many members fail to report to NHIF that they had been turned away by hospitals.
“However, for those who are able to come to us, we always intervene, and find out what the case is about,” she said.
She added that some of the cases of patients being turned away are attributed to failure to pay premiums or the card is not up-to-date.
“Sometimes they may be turned away without being given the proper reason,” she said.
She noted that it even becomes more complicated when it comes to outpatient services because members choose a particular hospital.
“If it’s a referral it must be something which is not within the contract of that hospital. So they are usually turned away and it’s something which is wrong, and we always follow up with the hospitals,” she said, referring to the new regulations due to public participation and approval.
She stated that the regulations are clear that if a hospital contracted by the NHIF turns a patient away, it gives the Fund a reason to withdraw their contracts.
There have been reports of patients with chronic illnesses who rely on NHIF card for treatment being turned away from hospitals.
Some hospitals have also declared that patients with NHIF cards will not be served until the insurer pays for past claims.
However, Nyachae said the issue is around the claims payment duration which has been pushed by week during which the claims are verified.
“In our contractual agreement with service providers, we do claims payment within a certain duration, in this case within 90 days. Here, hospitals used to be paid within two weeks when the claims come in, but it has reached a point where we have to verify,” she said.
Low retention
The insurer will this morning flag off a roadshow that’s expected to go round the country sensitising Kenyans about the importance of registering as members of the NHIF.
It expected to address the challenges of low retention of the informal sector who are voluntary contributors.
“Those who are retained are those who have chronic illnesses, because they are continually seeking the services. Some of the informal sector members, because of the voluntary nature of their membership, enroll when they have a need, utilize the benefits package then drop off after receiving services,” said Phylis Nyakiba, the Fund’s head of Corporate Affairs, Marketing and Communications.
