If you are a doctor relocating to Dubai or the wider UAE, you will need to become familiar with local medical insurance systems and regulations. In the UAE, the majority of medical treatment is paid for through insurance, as health insurance is compulsory for all residents.
For Emirati citizens, the government provides health insurance coverage within each emirate. Employers are mandated to provide insurance cover for their expat employees, and some companies also provide cover for dependents.
The amount of adjustment required to understand the medical insurance system will depend on the type of health system you have previously worked in. If you have worked in a national health system, such as in the UK, working with insurance providers may be unfamiliar to you.
How do insurance reimbursement systems work in Dubai?
Medical insurance systems use the Current Procedural Terminology (CPT) code to streamline communication between providers and payers. The globally recognized, evidence-based system known as the standardized CPT code keeps pace with modern medicine to set reimbursement levels. The CPT code enables increased efficiency through integrated digital systems, such as eClaimLink, established by Dubai Health Authority.
The code is also used to support health planning and research.In 2020, Dubai adopted the internationally recognised Diagnosis-Related Group (DRG) system for in-patient treatment.
The DRG classification system groups patients with similar characteristics and resource consumption to calculate a standardized insurance payout to hospitals.
What challenges can arise with insurance systems?
Due to the need for pre-approvals, we may not be able to carry out non-emergency tests and treatments on the same day. We do not always grant pre-approval requests on the first attempt.
Unfortunately, many insurance policies exclude congenital or genetic conditions, as well as some chronic or lifestyle-related conditions.
Patients with uncovered medical conditions can seek assistance from registered charities or foundations approved by the government to receive support.
The level of coverage varies between insurance companies and policies. If a patient’s insurance does not cover the hospital where you work, you may need to advise them on where they can access treatment.
The DRG system streamlines insurance approvals and payments and encourages efficient use of resources. It removes financial incentives, present in fee-per-service systems, for providing clinically unnecessary tests or treatment or prolonged hospital stays.
Tips for working with medical insurance companies in Dubai
- When you start at a new hospital or clinic, your employer should arrange for your training on the Dubai Medical Coding Manual and completing insurance applications.
- Feel free to ask for advice from colleagues. When you complete medical notes, make sure to document justification for any requested tests and planned treatment.
- This documentation can aid in getting insurance approvals. When an insurance provider denies a valid pre-approval, reapply with additional details or new reasons for the test or treatment’s necessity.
- Often, encouraging patients to call their insurance provider can highlight the importance of early approval. Be prepared to exercise patience while acclimating to a new insurance system.
- The DRG system makes insurance approvals and payments more streamlined. Promotes efficient resource use by eliminating financial incentives in fee-per-service systems, preventing unnecessary tests, treatments, or prolonged hospital stays. Applies to all.
