It is a pity that only about 10% of the population in Zimbabwe is covered under Medical Aid Societies, leaving the majority of the populace depending on out-of-pocket payments for their medical attention.
The Medical Aid Industry is not going as expected and for ages has thus shown stagnancy, leaving one to wonder why it is that way.
Despite many players delving into this industry, membership remains sluggish as people seem to lack confidence in medical aid societies.
There seems to be permanent acrimony between service providers and many medical aid societies and the root cause being of non-payment of dues, delayed payments and bully behaviour.
Many medical practitioners feel they are being strangulated by the egregious behaviour of the health funders who want to dictate everything in the medical industry.
Service providers are treated as if they are of no importance and relevance at all yet they are the protagonists in medicine.
Patients should know why many service providers reject their cards despite their schemes being US dollar ones.
It is the poor management of their schemes which results in them being denied medical attention because the behaviour of the funders does not change despite one contributing in US dollar.
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You hear of misuse of funds by some health funders and recently, Cimas was in the press for wrong reasons when the chief executive officer was accused of embarking on unviable expansion both locally and abroad, awarding of contracts to friends, siphoning of money through renovation of clinics and unsustainable costs and arrangement of loans for top management that cost the society more than US$10 million dollars.
Cimas clients should question where all that money is coming and whose money it is when they are denied medical attention by service providers who claim they are poorly paid.
I was flabbergasted when the same Cimas could not honour claims that we sent because there were missing ICD-10 Codes (International Classification of Disease 10th Revision).
Imagine offering emergency service to a bleeding patient who gets sutured and rehydrated using my own resources and then no cent is paid because of the so-called ICD-10 codes yet all the details, diagnosis and management are crystal clear.
This is day light robbery that should not be allowed to continue under the skin. The regulator should be firm when such complaints are raised as some of the actions of health funders are retrogressive in our quest to achieve universal health coverage.
This is the work of our so-called esteemed medical aid societies who capitalise on Pareto optimality to enrich themselves.
First Mutual is not left in the line as it plays dirty tricks to evade payments. It rejected claims merely because our claims manager had put US$30 as initial consultation.
Instead of just correcting down, the health funder saw it fit to reject the claims in totality yet service was rendered and the same MAS dreams of us accepting its clients without co-payments.
Deciding to throw away all such claims is tantamount to medical sabotage that should be condemned by all sober-minded persons.
Cellmed has also come in with its bag full of tricks to evade some payments. For is Ngezi Platinum clients, medical practitioners have been instructed to claim only US$5 as consultation, a figure which is a natural deterrent to accepting their medical aid card holders. Imagine sending a US$5 claim form to the medical aid and waiting for the money to be paid after 60 days that is preposterous!
The same Medical Aid Society has denied registration to new applicants who want to be on their platform especially those in Ngezi, a development which saw Ngezi-based doctors complaining to the Competition and Tariff Commission on August 8, 2023.
Fair practices are what everyone desires if the country’s health service delivery is to improve.
The country needs dedicated players in the health fraternity not opportunists.
A strong health delivery system is possible through six building blocks of service delivery, financing, governance, medicines, informatics and health workforce!
