"Doctors" and insurance companies... a confrontation over tariffs and deductions

The dispute puts the two parties before a test concerning the continuity of medical services provided to the insured, at a time when the two narratives diverge regarding responsibility for the failure of agreements, deductions on doctors' fees, annual fees imposed on the insured, and the extent to which the agreed tariff includes all payers of the medical bill.

In an announcement directed at doctors, the syndicate said it decided to stop dealing with non-compliant companies, justifying this by the insurance entities' non-compliance with the agreement concluded with them, and that it was unable, despite efforts made to resolve pending matters, to reach acceptable solutions that guarantee doctors' rights and prevent unfair deductions affecting their fees.

In contrast, the federation and the association expressed surprise and regret in a joint statement at the continued calls to stop dealing with a number of insurance companies and medical insurance management companies, despite previous clarifications and the commitment of insurance entities to understandings related to the medical tariff, pointing out that the application of the agreed tariff did not include all payers of the medical bill covered by it.

The syndicate explained that the decision was made in consultation with the cooperative fund committee and the private sector doctors committee, and that the first phase includes Medsol, MedNet, Al-Oula, and Newton companies, with the procedure expanding gradually. It pointed out that the companies raised the annual fees on the insured in the manner they see fit, while applying deductions on doctors' fees.

The federation and the association stressed that patients and the insured must not be a pressure tool in matters related to doctors' fees, and must not bear the consequences of strikes and media escalation, pointing out that past years witnessed repeated resort to strikes and media statements to demand wage increases, which placed the stability of the health insurance system and the continuity of services before repeated challenges.

According to the syndicate's announcement, a doctor can treat a patient insured by the companies included in the decision, but on a cash payment basis, provided that the patient is issued a fee receipt for the paid amount, while emergency cases and emergency hospital admissions and intensive care are exempt, as the doctor must treat these patients from all companies without exception.

Under the authorization granted to them by member entities, the federation and the association affirmed that any doctor's refusal to receive or treat an insured person constitutes a violation of their contractual obligations, and will entail taking necessary legal measures, including stopping dealing with them and excluding them from medical networks affiliated with insurance companies, insurance management companies, and insurance funds.

The syndicate called on doctors to commit to not dealing with those companies until their status with them is rectified.

The federation and the association announced that they will initiate a serious and comprehensive study to reconsider the existing contracting model with doctors, including the possibility of ending the medical networks system and moving towards a mechanism based on cash payment by the insured and submitting invoices to insurance entities in accordance with coverage conditions and approved controls, with the study aiming to evaluate alternatives to ensure sector stability and protect the rights of the insured.

The federation and the association reiterated their confidence in their doctor partners and their appreciation for their pivotal role in the healthcare system, stressing that respecting contracts and professional and contractual commitments, and not making patients bear the consequences of escalation, is a foundation that cannot be compromised, and that protecting the insured and the stability of the system will remain at the forefront of their priorities.