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Hospitals to drop HMOs Jan 31 over poor tariffs, debts

Private health care providers say they plan to jettison all contracts with private health insurance companies across Nigeria from January 31 owing to poor tariffs…

Private health care providers say they plan to jettison all contracts with private health insurance companies across Nigeria from January 31 owing to poor tariffs and the huge backlog of debts.

The president, Healthcare Providers Association of Nigeria (HCPAN), Dr Adeyeye Arigbabuwo, told a news briefing0 in Lagos that there was an abysmally low reimbursement by the Health Maintenance Organisations (HMOs) in private health insurance as against the rising costs of health goods and services.

He said healthcare providers suffered losses from the disparity between what HMOs offered as a premium on enrollees and the increasing cost of services.

To prevent withdrawal of services, Arigbabuwo said the association wanted HMOs to adjust existing contract documents using HCPAN tariffs as benchmark.

“The association will no longer tolerate owing providers in excess of 30 days as such HMOs will be mandated to pay cumulative interests on such debts,” he said.

The health care providers said in cases where valuations were not captured in tariffs, HMOs should engage with such groups, given that the issues may be broad and price changes could be unpredictable.

Arigbabuwo said there was need for periodic review based on trends of increases in the costs of health products and services.

He said the association had plans to tackle undue maltreatment and victimisation of its members, like undercutting service tariffs or unjust transfer of enrollees.

An enrollee of one of the HMOs in Lagos, Toke Yusuf, expressed fear that if private healthcare providers withdraw from private health insurance, it would affect many people, including her family.

“I gave birth to two of my children through HMOs in a private hospital of my choice. Without health insurance, my family would not be able to afford such facilities. After the annual payment, my antenatal, delivery and post-natal were free. I don’t wish to start patronising government facilities due to the huge crowd there.

“I cannot afford the fees of the private hospitals if HMOs are not involved. I hope the issues will be resolved and we can enjoy the health packages we have grown used to,” Mrs Yusuf said.

The chairman, Association of General and Private Medical Practitioners of Nigeria, Lagos State chapter, Dr Makinde Akinlemibola, said patients would suffer if private healthcare providers terminated their contracts with private health insurance companies by January 31 as they would have to pay out of pocket.

He however also noted that jettisoning the contract between the providers and the companies would send the right signal to the HMOs to be up and doing.

“Before the withdrawal was concluded, there must have been discussions, the timeline is now given most probably because the HMOs are not coming up with something satisfactory,” he said.

He called on the National Health Insurance Scheme to intervene in the situation.

“Things are going up every day and the HMOs are not ready to adjust their tariffs despite this. There is a backlog of debts that usually takes a very long time to pay.

“The longer it takes to offset the debts, the more devalued that amount is. Quite a lot of HMOs pay their debts as fast as possible, but some of them don’t pay,” he stated.

Akinlemibola said the proposed withdrawal would not have any major negative impact on private hospitals. “It’s even better we don’t continue with it as a lot of private hospitals including mine are incurring debts when they don’t pay on time. At the end of it all, the private hospitals will be the better for it.”

When contacted, the president of the Health and Managed Care Association of Nigeria (HMCAN), Dr Leke Osunniyi, said HMOs were currently dialoguing with HCPAN, and want more time to resolve the matter amicably.

He said: “HMOs are paid by the companies and private entities that pay them to provide the health insurance for their staff.

“So, we’re currently dialoguing with the leadership of the healthcare providers. In fact, I spoke with the president of HCPAN, Arigbabuwo, today (yesterday) and I implored him to as much as possible give us enough time to resolve the matter amicably.

“We have a list of tariffs, and we signed a document with our clients to say ‘okay we all agree that treatment of malaria, for example, will be N5,000, malaria test itself will be N1,000.

“However, the healthcare providers are saying ‘we can’t treat malaria for N5,000 anymore because the cost of things has gone up.

“But as HMOs, before that cost must go up, we have to go back to our principals – the companies and tell them that ‘we need more money, this money is no longer enough.’ For instance,

we may say ‘the N30,000 you are paying us is no longer enough. It has to go up to N60 or N70,000.’

“If we go to the managing director of a company to say this, for instance, he or she will say ‘don’t you know that the country is hard? Where do you want me to find N70,000 per person when we have an agreement and have signed a contract? You now want to change the goal post in the middle of the game.’

“So, we’ve told the healthcare providers that it is not our fault. We told them to give us time to negotiate the increases because it is a negotiation. If we meet the companies and they say they can’t pay N70,000, but since we have begged they can give N45,000 for now. Which is a huge jump in the business, then later in the year they can review it.

“We are not the ones generating the money. We are ourselves are employed by other people to do the work we are doing.”

The HMCAN president said the association does not blame healthcare providers because they know that prices of health services and goods have gone up as a result of COVID-19.

He blamed the problem on economic crises and inflation. “In many cases, they are asking for a 100 per cent increase and the budget of companies cannot accommodate that. Because they cannot spend all their money on healthcare. There are other things to do such as paying salaries.

So, this is our predicament. It is an industry-wide problem and honestly, everyone has a strong argument.”

He said instead of HMOs, healthcare providers should rather direct their plea to the private companies to increase their premium. “But like my people say when you pull the leg of something the whole body will follow. So maybe they are pulling us to say HMOs we are sending you to your bosses – we need you to review these tariffs as things are really bad.”

A source at the NHIS, who craved anonymity because he is not authorized to speak, said: “We are going to follow up with HCPAN. They are talking about private health insurance, not the government health insurance. Though we will also intervene between HMOs and the private healthcare providers association of Nigeria to make sure that the contacts are not jettisoned.

“We are already doing a lot in the area of recovery of debts for the providers, and we will ensure that the subscribers to private health insurance in Nigeria are not left stranded. Even today we will be making calls to make sure that we nip it in the bud,” the NHIS source said.

By Ojoma Akor (Abuja) & Risikat Ramoni, Lagos

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