Doctors fault insurers as Nairobi Women’s Hospital’s woes deepen

Nairobi Women’s Hospital, Mombasa branch. FILE PHOTO | KEVIN ODIT | NMG 

By NASIBO KABALE
More by this Author

By BONFACE OTIENO
More by this Author

Summary

• The fallout over claims of bills inflation at the Nairobi Women’s Hospital escalated on Wednesday, with doctors joining the fray as a number of insurers removed the facility from their list of approved service providers.
• Doctors, through their lobby, the Kenya Medical Association (KAM), on Wednesday demanded to sign fresh pre-authorisation (PA) deals “to prevent inflation of medical bills and limit cases where some hospitals fail to pay doctors for services rendered.”
• A PA is a requirement from health insurers that a doctor obtains approval before they authorise specific medicine, medical device or procedure.

The fallout over claims of bills inflation at the Nairobi Women’s Hospital escalated on Wednesday, with doctors joining the fray as a number of insurers removed the facility from their list of approved service providers.

Doctors, through their lobby, the Kenya Medical Association (KAM), on Wednesday demanded to sign fresh pre-authorisation (PA) deals “to prevent inflation of medical bills and limit cases where some hospitals fail to pay doctors for services rendered.”

A PA is a requirement from health insurers that a doctor obtains approval before they authorise specific medicine, medical device or procedure. The doctor typically completes a form showing why the prescribed medicine, device or procedure is medically necessary.

KMA said that growing disputes between medical underwriters and hospitals over bills have blocked payment for services rendered by some of its members.

“We want to meet with AKI (Association of Kenya Insurers) and come up with a contractual agreement that will ensure payment comes in good time which is beneficial to the patient and the doctor,” KMA secretary-general, Simon Kigondu said.

The official said the disputes between insurance firms and hospitals had locked millions of shillings, with doctors often bearing the brunt.

This comes in in the wake of a feud between health insurers and the Nairobi Women’s Hospital over claims of inflating patient medical bills.

Tom Gachuhi, the AKI chief executive on Tuesday announced that health insurers would no longer honour future bills from the hospital.

Several medical underwriters including CIC, AAR and UAP Old Mutual have since formally removed the Nairobi Women’s Hospital from their list of approved healthcare providers and urged patients to seek services from other facilities countrywide.

The Kenya Revenue Authority has also suspended the hospital from its list of service providers and staff advised to visit other facilities till matter is resolved.

The suspension followed leaked WhatsApp chats, which appeared to show how the hospital bosses set daily targets for the number of patients who should be admitted.