Since the full implementation of mandatory health insurance across the UAE in 2016, there has been a surge in medical claims across the insurance industry. In March 2016, the Gulf News reported that approximately 11% (AED 4 billion) of the AED 33 billion health insurance claims made by individuals and health providers were due to insurance abuse and fraud. This figure is likely to have risen considerably since then and the regulatory authorities have been exploring ways to manage the ongoing abuse.
As a patient, there are ways you can reduce your financial exploitation by health providers and compel them to regard you as a patient with medical needs rather than a lucrative wallet they can tap. Here are three tell-tale signs that your attending doctor is taking you for a ride.
1) Asking for Tests Irrelevant to Your Present Complaint
Whilst you may not know if you really require a full Lipid Profile or just a simple random blood sugar when you report continuous fatigue, you can grow suspicious when you present your GP with a short history of knee pain and he requests a full-blood count and a Vitamin D blood test.
The knee ache is likely due to soft-tissue or skeletal damage and the first rule of action ought to be a simple x-ray. You are not expected to assess the necessity of a requested investigation, but always ask your doctor why he/she is prescribing this test/examination and what it is they are ruling out because of its results.
2) Requesting Sophisticated Examinations on First Encounter
Some examinations require long and expensive procedures which are often reserved to more complicated cases when the less-expensive and conclusive tests did not yield a solid diagnosis. Unfortunately, many doctors by-pass the standard medical protocols and request these sophisticated examinations to charge the insurance companies and unsuspected self-paying patients extra sums.
For example if you complain to your GP about occasional headaches, he/she may straight away prescribe an MRI; a rather long and sophisticated examination that not only can show the soft-tissue but also the brain blood flow. The procedure was prescribed to you NOT because you require it, but because the prescribing health provider can bank the considerably larger payment difference.
Always ask your doctor why he/she favours one examination over another and how the learnings they are expecting to gain from the procedure will aid in drawing a treatment plan.
3) Prescribing Branded Medication When Generic Alternatives are Available
When the patency of a medication expires, and other companies can manufacture the same formula, this medication is then deemed to be a generic. Generic medicines are always cheaper and often as effective as branded medicines. Unfortunately, since profit margins are significantly lower, health providers in collaboration with pharmaceutical companies and pharmacies often opt to prescribe branded medication to reap greater profits.
For example, paracetamol is a generic pain killer that is manufactured by numerous companies. Tylenol is the trade name of the brand manufactured by McNeil Consumer Healthcare; a subsidiary of Johnson and Johnson. If your doctor prescribes Tylenol instead of paracetamol, you should be concerned.
You will not know if there is an equally effective generic medication, but you can check here on this website or simply ask your doctor.
In all cases you should always listen to your doctor's advise. You have the right to ask questions and request clarifications, but remember that it is they who went to medical school and not you.