The National Health Insurance Fund (NHIF) on Monday, May 15, threatened to drop contracted hospitals that turned away registered patients over the fear of Ksh12 million arrears.
Speaking during a public engagement forum, NHIF Nairobi regional manager Mary Nyachae stated that such hospitals violated the contractual obligations with the insurer.
Further, she pointed out that the hospitals denied patients medical services in response to the new claims verification measures.
In a breakdown of the measures, Nyachae affirmed that payment claims were initially paid to hospitals within two weeks but the new rules prompted NHIF to verify the claims before remitting the funds.
"In our contractual agreement with service providers, we do claims payment within a certain duration, in this case within 90 days. Here, hospitals used to be paid within two weeks when the claims come in, but it has reached a point where we have to verify," she indicated.
In other circumstances, she claimed that some patients were being turned away as the hospitals did not offer the services being sought. Alluding to this, Nyachae noted that the facilities ought to direct the patients to another institution that offered the service.
She disputed claims that the Fund was broke, arguing that the issue is primarily based on inadequate sensitisation to the public.
Nyachae reiterated that some of the cases of patients being turned away were as a result of unpaid monthly contributions or failure to pay premiums.
She noted that outpatient services bore the brunt of the situation as they are restricted to a particular hospital.
“If it’s a referral it must be something which is not within the contract of that hospital. So they are usually turned away and it’s something which is wrong, and we always follow up with the hospitals,” she highlighted.
Initial reports indicated that NHIF owed hospitals Ksh12 million in arrears that accumulated since 2022.
This affected hospitals that had signed a comprehensive cover agreement with the Fund - indicating that patients would receive services without paying the healthcare provider.
