Thursday, December 11, 2008

We've got you covered

After my recent experience at Welcare – the aching and numbness has gone now, thanks for asking – I made an appointment to see a doctor for a wholly unrelated medical issue. Let’s call it foot ‘n’ mouth. Only the name has been changed. And the symptoms. There are no lurid pictures from the Tropical Diseases House of Horrors either.

I turned up at Welcare and proffered my medical insurance card. Last time I did this, all medical bills were paid directly and painlessly by the insurance company to the clinic apart from a Dh50 deductible excess. This time, the receptionist looked down his nose at the card.

“Your complaint is not covered, Mr Goat.”

“Excuse me? I have already checked the list of specific exclusions on my policy and as foot ‘n’ mouth isn’t a self-inflicted injury, cosmetic surgery or a dental complication it’s not excluded. Please check with the insurance company.”

“There’s no need. Foot ‘n’ mouth is never covered.”

Anyway, having made the appointment I found out how much it would cost in full and I had the treatment. Ouch, that stings. And so did the treatment.

A week later I’d been through the medical insurance policy with a fine-tooth comb. I had the same argument at Welcare, but this time I managed to get, along with the invoice, a doctor’s note detailing the treatment. This I submitted to the medical insurance company who confirmed that foot ‘n’ mouth was indeed covered, and that I could expect a cheque for full reimbursement, less the Dh50 deductible.

A month later I have the cheque. As well as the Dh50 compulsory excess, the company deducted 20% “because you didn’t show your insurance card at the clinic.” Well I did, actually, but Welcare refused to accept it. They lied to me. They failed to check when I queried their disingenuity. And anyway, the small print says that costs at Welcare are 100% recoverable.

The foot ‘n’ mouth has now cleared up. Yet I am still battling to recover sums owed to me in accordance with my contract with the medical insurance company. What a pity that the clinic and insurance have together conspired to make the financial side of healthcare so unnecessarily complicated.



R Bailey said...

Welcare are special !

After a day surgery the wouldn't let me leave and said I had to stay overnight because the accounts department had gone home. Solved that, I just walked out, there head of finance finaly called to appologise two days latter. The doctor who was treating me thought is was very funny.

Another famous "discussion" was so loud that some of the doctors in the offices came out, one even started laughing, another applauded. I was being repeatedly charged a deductible (for the same broken bones) as I was only going to see them every two weeks not seven days, simple just wend every 7 days and the insurance company paid twice as much !

p.s. on a serious note hope they sorted it.

Doctors = Okay
Finance / clerks = Traffic Wardens

Mars said...

ou should see the movie "sicko" by micheal moore. that's scary.

Seabee said...

Time to change to a less commercially minded medical facility Mr Goat. Welcare has a well deserved reputation for this kind of attitude

i*maginate said...

OK thanks - will make sure my mother never goes to Welcare!

She had an operation at Cedars (I recommended it coz I went there and found them OK - note 'OK' applies, not GOOD lol!) and it was ... OK.

You can expect doctors who prob don't earn much. When the op was over, they said my mum can't eat so and so. Turns out it was not because of the dietary instructions but because the fat cow in the kitchen, apparently closed, was too lazy to make anything. So I went there myself with the nurse, heated some stuff up (mummy hadn't eaten for 24 hours!) and gave it to her myself.

Yeah and they couldn't even get the paperwork straight, and in the morning, they didn't even tell us what time the OP was.

Imagine a daughter sending her mum off to the OP, not knowing if the doctors know how to do their job, but knowing you don't have another option.

In this country, you put your life in other's hands. We all know why.

Now - do you guys have any recommendations for hospitals? Would be much appreciated.

the real nick said...

American Hospital is OK, as long as the insurance pays. BUPA does.

Jayne said...

When I got a quote from LaughLines hospital for grandma's op earlier this year, it was Dh20,000. After a coupla weeks, the figure went up another 150%. When I asked for a detailed statement, the 'accounts' (<-- read thumb suckers) wobblers told me they couldn't "break it down". I told them that I couldn't pay them until they did. I bitched & moaned, ad nauseum until the bill was reduced & then made 'em wait another month before coughing up the dosh. Thankfully grandma's medical cover in SA reimbursed us the whole amount.
I don't understand why medical insurance companies here don't insist on a total breakdown of the charges. Is this normal?

i*maginate said...

Thanks, Nick, will look into it.

Don't care who pays, just want decent doctors and a competent service.

i*maginate said...

Jayne, I have no idea.


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