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Lebanese crisis: Health insurance coverage in danger !

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Health insurance coverage in Lebanon no longer covers the needs of a sick person or protects an aggrieved person, at least in the current stage, before it is completely transformed into an exclusive service for the rich and affluent. Most of the insurance contracts currently in force have become formal contracts that fail to protect the insured, whether in terms of their property or health.

The difference in hospital costs caused by the rise in the exchange rate of the dollar, from 1,500 to more than 20,000 pounds, was placed on the shoulders of insurance policy holders, as neither insurance companies are willing to bear the difference in the exchange rate of the dollar, nor are hospitals ready to deal with the crisis on a non-commercial basis. Only the owners of insurance policies bear the burden of obtaining the hospital service from their own pockets, at a time when insurance policies do not bear more than 25 percent of their bills.


Today's Insurance Reality

“Medicine without insurance is less expensive than with insurance.” This is the summary of the reality of insurance today. This result was not issued by a client of an insurance company, but rather by a senior official in one of the guarantors. The difference in the cost of the hospital service in the event that the patient was covered only by one of the guarantor institutions, is much less than the difference in the case itself in the event that the patient was covered by a private insurance company, especially if the treatment was a first degree, as the responsible source confirms in his talk to the cities". The difference in the hospital bill for childbirth, for example, amounts to 4 million pounds if it is covered by the National Social Security Fund. In the case of coverage by an insurance company, the difference is then 7 million pounds, and the reason is that the hospitalization tariff on insurance is higher than that of guarantor institutions.

Hence, many patients currently resort to concealing the issue of contracting with insurance companies when they enter the hospital, and the source reveals many cases that exposed collusion between the patient and the insurance company, requiring the patient to be admitted to the hospital with coverage from the insurance only, without showing him the insurance card, and therefore, the Paying the difference in the bill by 10 percent according to the social security tariff, to return and collect it from the insurance company outside the hospital. In this case, the insurance company has saved money and reduced the value of its bill for the patient, compared to what it would have cost the hospital, while the patient also saved what he could have incurred for the hospital from the difference in the bill resulting from the dollar exchange rate. This ploy succeeded with many, according to the source, but in many cases, the hospitals were controlling the collusion between the two parties and obliging them to pay the difference in the bill.

This reality of attraction and deception reveals the depth of the hospital crisis and chaos in the Gaza Strip, says the source, as the patient costs huge differences. There are insurance companies that evade coverage entirely, especially when it comes to a degree difference between insurance and social security. In this case, the patient, specifically the cancer patient, resorts to continuing his treatment on the responsibility of the insurance only, without benefiting from insurance, in order to reduce the burden of the difference in the bill.


Never ending tricks

Insurance companies outdo themselves by inventing tricks to exploit patients. It has succeeded in imposing a new reality today that requires each company to deal with its insured in a manner commensurate with its ability or perhaps its will. The official exchange is 1500 pounds, leaving the patient with the responsibility to face his fate with the hospitals.

Insurance expert Hossam Shari summarizes the reality of insurance in his talk to Al-Modon by saying, "People today are not insured in one way or another." Each insurance company has a different pricing than the other and a completely different method of coverage.

With regard to compulsory insurance, insurance companies charged the official tariff in the vicinity of 65 thousand pounds, and covered the official exchange rate of 1500 pounds. Given that the dollar exchange rate has reached 20,000 pounds, health coverage becomes non-existent, but some companies have raised the mandatory insurance fee and adopted full coverage, such as Arope, which raised the mandatory insurance tariff to 130 thousand pounds, but today it does not cost the insured any differences, unlike other companies . There are companies that have raised their mandatory insurance tariffs to 100,000 pounds, but they cover the hospital bill at an exchange rate of 3,900 pounds, including Fidelity and Victoire. On the other hand, many companies continued to adopt the official mandatory insurance tariff, i.e. 65 thousand pounds, without covering hospital bills, except according to the official exchange rate of 1500 pounds, and assigning the rest of the bill to those affected.

Coverage and pricing chaos

As for car accidents, some companies still pay the insured's dues, at the official exchange rate of 1500 pounds to the dollar. And others pay at the price of 3900 pounds to the dollar. In the event of a major accident, theft and burning, companies pay by checks in bank dollars (i.e. dollars) exclusively, even if the policy holder does not have a bank account. This leads the insured to lose more than 85 percent of the value of the insurance compensation.

In terms of regular hospitalization, each company has its own payment system, while all companies participate in the issue of stopping the outpatient coverage, that is, medical examinations and others outside the hospital. As for hospitalization coverage (inside the hospital is emergency and hospitalization), there are companies that cover 3900 pounds to the dollar, while some companies set very low ceilings for coverage up to 100,000 dollars, or 150 million pounds, according to contracts. This means that the insured's admission to the hospital once to the hospital may drain the entire balance of the insurance policy. On the other hand, there are companies that set high or unlimited ceilings.

In short, the way to deal with the issue of insurance varies between companies and differs with one company from one case to another, and this is due to the absence of any oversight or care for the health insurance file of citizens, especially in cases of companies evading coverage, as a hospital case. For example, in the American University Hospital, where the Medical Express company evaded covering any medical or hospital costs, except for the daily room rent. Note that the aforementioned company covers the exchange rate of 3900 pounds, not in dollars.

New insurance contracts

The president of the ACAL Association of Insurance Companies, Elie Nisnas, did not deny the chaos in the insurance sector and the difference in coverage pricing from one company to another. Hospitals stick to the request for the hospital bill in dollars. Therefore, health coverage is carried out with the imposition of financial differences on the patient, especially when medical supplies are involved. The crisis is mainly related to the requirements.

In his interview with Al-Modon, Nisnas confirms that any new insurance contract will be concluded from now on in fresh dollars. The reason is due to the fact that hospitals charge their bills based on the real dollar exchange rate, ie the fresh dollar. Also, the cost in dollars will be lower than previous contracts by about 25-30 or 35 percent, according to Nisnas.

Emphasizing that insurance companies today offer many insurance products that are compatible with most budgets, but all of them are in cash dollars exclusively, he points out that the percentage of contracts will definitely decline, and the Ministry of Health must price medical supplies such as medicines, in order to unify prices and costs.

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