Watchdog expresses concern

THE consumer watchdog has expressed concern over the insurance cover offered by some companies that directs clients to public health facilities.

Consumer Council of Fiji CEO Premila Kumar said some insurance companies were clogging the country’s public hospitals and health centres by referring insured patients to seek treatment at those facilities.

“How are the insured candidates gaining by having a health insurance cover that directs them to the public health facilities?” she questioned.

She said they recently came across a case where a client, with health insurance, fell ill in Suva and lodged her claim for coverage under the policy with her insurance provider. Her request was declined.

“The insurance provider stated that under the terms of the policy, treatment at any approved private medical facility (APMF) is covered only if treatment is not available at a local public hospital,” Mrs Kumar said.

“In a letter to the council, the insurance provider said they endorsed treatment at any APMF and would assess the information in light of whether the policy was valid, type of cover and whether the treatment was medically necessary, and whether the treatment was not available at the local public hospital.

“The company stated the mandatory procedure for approval to undergo treatment at a private medical facility if the insured fell ill outside the place of his or her normal residence as stated in the policy under the terms of a value care policy, the patient must first seek hospitalisation at any local public hospital regardless of the location. If the treatment is not available at the local public hospital then the patient can be treated at APMF.”

CWM Hospital consultant and physician Mai Ling Perman said most patients were referred to CWMH and if treatment was not available they were referred overseas.

However, the assistant professor at FNU’s Hoodless House said most services were provided at CWMH.

“If the service is not available here then most likely the patient is referred overseas. You go with your medical insurance; if it’s not available there then they will refer you here — it’s not the other way around.”

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