The Social Health Authority (SHA) says it will refund patients who footed their medical bills out of pocket when the National Health Insurance (NHIF) system was disabled.
SHA chairman Abdi Mohamed on Sunday said only those who spent their money after September 30, 2024 midnight were eligible for the refunds and asked all those who were affected to reach out to the authority
SHA Chief Executive Office Elijah Wachira said they would also pay for all outstanding cases where NHIF had given an undertaking before October 1, 2024.
“All patients whose admissions or procedures commenced after 30th September 2024 will have their bills settled under SHA, there is no lacuna,” he said.
Additionally, for patients who had already spent more than what was approved by SHA benefits, the CEO asked them not to worry.
“These instances happen once in a while where you will find that certain procedures have limits that are below what a hospital is charging. Hospitals are at liberty on many occasions to charge for conveniences over and above the basic treatment,” he said.
Basic treatment
“This is why SHA is assuring Kenyans that we shall pay for the basic treatment across the board and we are paying a tariff per condition across the board for everyone. And so what is happening is that it depends on the facility where the patient went to seek service and there may be a need for a top-up.”
This came as some Kenyan patients who left the country last year to seek treatment abroad using their NHIF cards disclosed to Nation they were stranded after foreign healthcare providers started compelling them to pay out of pocket.
“The hospital could not accept NHIF for payment because they were concerned about the transition from NHIF to SHIF,” a Kenyan mother whose child has been hospitalised in New Delhi, India, for almost a year now, told Nation on Sunday.
“With the ongoing transition, there’s uncertainty about whether and when exactly SHIF will reimburse the money,” she said.
Dr Mohamed and Mr Wachira spoke after a five-hour meeting with healthcare providers at the SHA headquarters (old NHIF Building) in Nairobi.
According to the SHA chairman, they have ironed out all issues with healthcare providers around the country and have on-boarded the majority of all levels of health facilities.
“We have as of today, October 6, 2024, registered a total of 12,704,548 members into SHA. This number includes verified members who were under the defunct NHIF and have been transitioned to SHA,” he said.
“We have also noted that most beneficiaries are registering but not adding their dependants, we call upon them to do so for them to access healthcare services.
As for private and faith-based health centres, as of Sunday, a total of 1,442 health facilities had returned duly signed contracts and were therefore providing services to SHA-registered beneficiaries, Dr Mohamed said.
“Yesterday, (Sunday) we reported a total of 1577 health facilities contracted, however, this was an error due to duplication of names of some facilities, the list of all contracted health facilities is available on our official website.”
“After our engagement with private and faith-based hospital associations, we have agreed that all their facilities shall return duly signed contracts latest Tuesday this week on 8th October 2024,” the chair said adding that the healthcare providers had committed to ensuring continued healthcare access to all those registered under SHA.
On the SHA e-claim system, Dr Mohamed noted that during the initial days of the roll-out, they experienced challenges on the SHA e-claim portal— particularly on member verification and claim processing.
System challenges
“We have since addressed the system challenges and we wish to assure and confirm that the e-claims system is now up and running, a total of 10,904 end users have been trained, enrolled and their credentials sent and the services are currently available on the SHA e-claims portal,” he said.
“For healthcare providers who have not yet received credentials SHA has circulated a provider portal user form onboarding form,” he announced while urging healthcare providers to fill and submit the form immediately.
SHA also says that the claims system under the defunct NHIF system will, however, continue to be in operation.
“For member verification, discharge of patients admitted before October 1st this year, and for claims management of active enhanced schemes whose contracts have not yet expired,” Dr Mohamed explained.
On the issue of pending bills and bills arising during the transition, a joint committee between healthcare providers and the government chaired by Medical Services Principal Secretary Harry Kimtai shall be constituted to undertake verification of all pending bills incurred.
“We have committed to healthcare providers to prioritise the bills accumulated during the transition and as a result, there shall be frequent consultations with them,” he said.
Lauding Dr Mohamed’s sentiments, Dr Lishenga, the chairman of the Rural Private Hospitals Association of Kenya (RUPHA) said that they were happy to be onboarded.
“I want to tell healthcare providers, especially in rural Kenya, that we have received reassurances from SHA that the NHIF portal you have been using to verify claims remains open and you can continue to use it before offering service.
We have also received assurance that the SHA portal for claims will be up and running within 24 hours, I know there has been significant worry but we have been reassured that all is sorted,” he said.
Speaking to Nation on the sidelines of the meeting, Mr Kimtai assured Kenyans that the government would close all the gaps as it rolls out the new national health scheme.
“There was a slight challenge of communication especially between us and the healthcare providers but now we have opened all channels including a toll-free number that they can reach us on, a call center and have employed additional staff to cope with all that, “he said.
Source link : https://nation.africa/kenya/health/sha-to-refund-patients-who-paid-medical-bills-out-of-pocket-4787476
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Publish date : 2024-10-06 14:56:55
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