Health Insurance

Health service providers have been asked to stop demanding payment for services and drugs already covered by the National Health Insurance Scheme else they would face severe punishment.

Mr. Kwadwo Antwi-Boasiako, Public Relations Officer (PRO), Mampong NHIS, who made the call, said that already, some private health providers in the Asante Mampong area, who flouted the capitation policy have had their accreditation withdrawn.

He told the GNA in an interview that it had come to the notice of managers of the scheme that some private health providers in Asante Mampong area with NHIS accreditation were engaging in co-payment.

Mr. Antwi-Boasiako explained that co-payment is the practice where subscribers are made to pay bills for services and drugs, which are again submitted by the service provider for claims.

He said in some instances, subscribers were denied receipt for payment made to health providers.

Mr. Antwi-Boasiako said: ?it is unethical, irreligious and inhuman for health providers, who know that patients are already in a state of agony and psychological discomfort; to make them pay fees for drugs already taken care of under the NHIS.?

He said such illegal practice undermined the capitation policy meant to address leakages in the health insurance (old) system that created a window of opportunity for some providers to make claims for services and drugs they never provided to subscribers.

Mr. Antwi-Boasiako explained that capitation is advance payment per head for subscriber made to provider by the NHIS depending on the total number of people who chose that facility.

He said prior to the introduction of capitation policy, Ashanti Region recorded as much as 19 to 25 per cent of the total national bills for claims, though the region was not the most densely populated.

Mr. Antwi-Boasiako said in some instances claims for pregnant women had names of men raising suspicion of fraud.

He asked subscribers of NHIS to lodge complaints at the complaint units of the public relations office of the various scheme centres across the country to enable officials address challenges.

Source: GNA


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