Health insurance complaints go online in Dubai

Patients can alert iPROMeS about coverage failure or insurance card abuse claims Dubai: Residents can now complain about their insurance provider through a new online system launched by the Dubai Health Authority (DHA), officials said. Called iPROMeS, the portal allows insured residents in Dubai to lodge complaints or suggestions by filling out an online form on the system’s website, www.eclaimlink.ae/ipromes. They can alert the DHA if they believe the company refused to cover a service or health test that the insured member is entitled to as part of the policy, an official said. Covered residents can also complain if they feel their insurance card was “abused” by their healthcare provider, by putting them through unnecessary tests or procedures. Related grievances can be lodged through the online form, and the system then emails back a ticket number for tracking the case. Users also have the option to attach copies of supporting documents and confirm a willingness to “testify if this matter goes to a formal hearing.” “Some of the problems of entitlement are very straightforward and can be resolved quickly. However, some complaints are more complicated and resolution of such cases could take up to a maximum of few weeks,” said Dr Haidar Al Yousuf, Director of Health Funding at the DHA. However, the DHA has pointed out that iPROMeS — Insurance Partner Relations Opinion Management e-System — is not just for complaints. Feedback like suggestions and even compliments are encouraged to help improve Dubai health services, it said. “While accountability is important, it is equally important to appreciate the work of insurance service providers,” said Al Yousuf. Launching the service on Thursday, Essa Al Maidoor, Director-General of the DHA, said: “In line with the vision of His Highness Sheikh Mohammad Bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai, and in keeping with the Dubai Strategic Plan 2015, the DHA is pleased to introduce this portal. “The portal provides insured members with a dedicated forum to express their opinions, feedback, suggestions and complaints with regards to health insurance services in the Emirate.” Al Maidoor added: “This is one of the important steps prior to the implementation of the mandatory health insurance for Dubai. It ensures accountability and such regulatory practices are essential to ensure transparency, fairness and efficiency in the health insurance sector in Dubai.” Officials have been for years working towards introducing compulsory employee insurance coverage in Dubai, and a draft law is said to be in the final stages of approval. Low-income expat patients often struggle to pay for treatment at private facilities, and the problems are confounded during emergencies. The coverage rule is already in place in the capital Abu Dhabi, with basic and enhanced coverage based on workers’ salaries and other factors. Employers there have several state-approved insurance companies to sign up with under the scheme. Meanwhile, a number of insurance companies in Dubai welcomed the news, saying iPROMeS will provide an organised avenue to address outstanding issues. -Gulfnews [caption id="attachment_31036" align="aligncenter" width="475"] Image Credit: Pankaj Sharma/Gulf News archives
Surgical Intensive Care block of Rashid Hospital, Dubai.[/caption]