UAE Health Insurance Cards ... The Codes Explained
"Why do I have to pay you Dhs. 50.00? I have medical insurance!", shouts one patient at the reception staff of one Bur Dubai polyclinic. This classic scenario is repeated across many clinics in the city and a similar scenario takes place after 3 months between the medical provider (the clinic/hospital) and the insurer (insurance company/Third Party Administrator) when payment is due. In a nutshell, it is not always clear: WHO HAS TO PAY WHAT!
With insurance companies using multiple payment codes and/or abbreviations to denote to medical invoice co-payments, it is no wonder that a state of chaos looms across the industry on this front. Some health insurance card specify '10% Other Serv' referring to radiology and lab examination procedures, others denote to them as 'Diag' short for diagnostics, few indicate 'Lab & Radio' and some leave it open to interpretation by writing only '15% OP' referring to any outpatient visit.
For those outside the health industry, IP, OP, DIAG, PH, MAT etc... signify nothing. Unless it is communicated in a training session or accompanied by an initiation protocol, it is unreasonable to expect patients to understand such codes. So here are the most common abbreviations and their corresponding signifiers. Obviously, when in doubt, call-up your insurance provider and ask!
For those within the health industry, it is proving to be fairly tricky to learn all the different codes each insurance company uses to refer to the same service.
"It is misguiding and complicated. They just want to make it difficult and trap us. They say it's mentioned on the card. Worst part is that the info to patients is different to the info to provider. On the card it says one thing and on their insurance claim system it says another", complains one Clinic Administrator in Dubai.
Indeed, inconsistencies in the abbreviations and codes for services across health insurance cards, inconsistencies between online systems and printed health insurance cards and inconsistencies within the very same medical provider manuals as per the below example result in confusion, frustration and ultimately financial losses.
Perhaps the easiest way to resolve this problem is to unify all abbreviations in the same manner that medical symptoms are unified under a single ICD Codes System and medical examination procedures are unified under the updated CPT Codes System.
Will the acting health authorities please review!