Saudi Gazette report

RIYADH — The General Secretariat of the Council of Cooperative Health Insurance (CCHI) has issued directives to health service providers to receive emergency patients, who are classified by the Ministry of Health as resuscitation and emergency cases, without requiring the beneficiaries to pay any costs for the treatment and restricting the payment directly to the insurance companies.

Dr. Othman Al-Qasabi, the spokesman of the council and executive director of supervision and empowerment, said in a statement on the council’s official Twitter account, that the council’s General Secretariat confirmed to all qualified insurance companies and approved service providers the necessity to provide treatment for emergency cases directly without the need to refer to the insurance company. However, the company must be informed within a maximum period of 24 hours from the time of receiving the case so that the service provider’s right to compensation does not lapse if it is late in reporting without any acceptable excuse.

Al-Qasabi said that the insurance company has the right, in the event of failure to continue treatment with the service provider, to transfer the insured client to another health service provider within the network of approved service providers to the insured and this is after his/her health condition has stabilized. He called on the insurance companies to pay the health service provider’s claims according to the price list and the mechanism agreed upon in the contract signed between the two parties.

In the event that there is no contract for the service provider with the insurance company, Dr. Al-Qasabi said that the circular of the CCHI requires the insurance company to pay claims directly to the health service provider for the period spent by the insured client to receive treatment based on the specific prices approved by the Ministry of Health.

He emphasized that the statutory procedures will be taken against those who commit violations or not complied with the directives of the CCHI Secretariat.