JEDDAH: The Council of Cooperative Health Insurance (CCHI) has found 10 violations against six health care providers and one health insurance company. The violations were dealt with according to the established procedures.
The council’s spokesperson, Yasser Al-Maarek, said that the department of supervision carried out 200 inspection rounds on certified health insurance companies and health care providers in 10 cities and governorates.
Al-Maarek said that the council gave great importance to monitoring and oversight in order to raise the level of commitment to CCHI’s regulations, the executive regulations and council decisions that guarantee the provision of health care services that are appropriate for the insured. This is while safeguarding the rights of the insurance parties and protecting the market’s integrity from any negative practices.
He explained that the council relies on various mechanisms to monitor violations in the private health insurance market. These include an automated system for issuing documents that enables compliance with laws and regulations and the hidden shopper technique of inspection visits to health insurance companies and health care providers, as well as fraud reports that reach the council from all parties to the insurance relationship.
Al-Maarek said that the most prominent violations were represented in: Failure to comply with the conditions for accepting the issuance of health insurance, failure to adhere to the criteria to request approval for a medical service, weak electronic systems, delay in paying financial claims to service providers, submitting fake claims to insurance companies, violations related to a delay in submitting financial claims to insurance companies, delay in sending approval requests to insurance companies, dealing with service providers that are not certified by CCHI, providing the council’s general secretariat with incorrect information, and not providing health insurance for Saudi workers and members of their families.
He said that the council was keen to control private health insurance operations and protect the market from any wrong practices, in a way that contributes to achieving the council’s vision to be a global pioneer in enhancing the quality of health services by raising the efficiency of private health insurance.