PPrivate healthcare providers say they plan to drop all contracts with private health insurance companies across Nigeria from January 31 due to low tariffs and huge backlog of debts.
The President of the Health Care Providers Association of Nigeria (HCPAN), Dr. Adeyeye Arigbabuwo, told a press conference0 in Lagos that reimbursements by Health Maintenance Organizations (HMOs) in the Private health insurance was extremely low compared to the rising costs of health goods and services.
He said health care providers suffered losses due to the disparity between what HMOs were offering as a premium to enrollees and the rising cost of services.
To prevent withdrawal of services, Arigbabuwo said the association wants HMOs to adjust existing contract documents using HCPAN tariffs as a benchmark.
“The association will no longer tolerate owing suppliers more than 30 days, as these HMOs will be mandated to pay accrued interest on these debts,” he said.
Healthcare providers said that in cases where ratings were not factored into pricing, HMOs should engage with these groups, as the issues can be wide-ranging and price changes can be unpredictable.
Arigbabuwo said there is a need for periodic review based on trends of increasing costs of health products and services.
He said the association has plans to address the undue abuse and victimization of its members, such as reducing service rates or unfairly transferring registrants.
A registrant from one of the HMOs in Lagos, Toke Yusuf, expressed fear that if private health care providers withdraw from private health insurance, it will affect many people, including her family.
“I gave birth to two of my children through HMOs in a private hospital of my choice. Without health insurance, my family would not be able to afford such facilities. After the annual payment, my prenatals, deliveries and post-natals were free. I don’t want to start going to government facilities because of the huge crowd there.
“I can’t pay for private hospitals if HMOs aren’t involved. Hopefully the issues will be resolved and we can enjoy the health packages we have grown accustomed to,” Ms Yusuf said.
The President of the Association of General and Private Medical Practitioners of Nigeria, Lagos State Chapter, Dr. Makinde Akinlemibola, said patients would suffer if private healthcare providers terminate their contracts with the companies. private health insurance companies by January 31, as they would have to pay out of pocket.
However, he also noted that abandoning the contract between providers and companies would send the right signal to HMOs to get up and running.
“Before the withdrawal was concluded there must have been discussions, the timing is now given most likely because the HMOs are not coming up with something satisfactory,” he said.
He called on the National Health Insurance Scheme to intervene in the situation.
“Things are increasing every day and HMOs are not ready to adjust their rates despite this. There is an arrears of debts which usually take a long time to pay.
“The longer it takes to clear the debts, the more this amount is devalued. A lot of HMOs are paying their debts as fast as they can, but some of them aren’t paying,” he said.
Akinlemibola said the proposed withdrawal would have no major negative impact on private hospitals. “It’s even better that we don’t continue because a lot of private hospitals, including mine, run into debt when they don’t pay on time. In the end, private hospitals will be better off.”
When contacted, the President of the Health and Managed Care Association of Nigeria (HMCAN), Dr Leke Osunniyi, said the HMOs were currently in dialogue with the HCPAN and wanted more time to resolve the matter amicably. .
He said: “HMOs are paid for by companies and private entities who pay them to provide health insurance for their staff.
“So we are currently in dialogue with the management of the health care providers. In fact, I spoke with HCPAN President Arigbabuwo today (yesterday) and implored him to give us as much time as possible to resolve the matter amicably.
“We have a price list and we have signed a document with our clients to say ‘okay, we all agree that malaria treatment, for example, will cost N5,000, malaria test will cost him -even will cost N1,000.
“However, health care providers are saying ‘we can no longer treat malaria for 5,000 naira because the cost of things has gone up.
“But as an HMO, before that cost goes up, we need to go back to our principals – the businesses and tell them ‘we need more money, this money is not enough anymore.'” For example,
we can say “the N30,000 you pay us is not enough anymore”. It must go up to N60 or N70,000.’
“If we go to the general manager of a company to say that, for example, he or she will say ‘don’t you know that the country is tough? Where do you want me to find N70,000 per person as we have an agreement and signed a contract? You now want to change the goal post in the middle of the match.’
“So we told the health care providers it wasn’t our fault. We told them to give us time to negotiate the increases because it is a negotiation. If we meet the companies and they say they can’t pay N70,000 but since we begged they can give N45,000 at this time. Which is a huge leap in the business, and then later in the year they can see it again.
“We are not the ones generating the money. We ourselves are employed by other people to do the work that we do.
The chairman of HMCAN said the association does not blame healthcare providers as they know the prices of healthcare services and goods have increased as a result of COVID-19.
He blamed the problem on economic crises and inflation. “In many cases they are asking for a 100% raise and the corporate budget cannot accommodate that. Because they can’t spend all their money on health care. There are other things to do like pay salaries.
So that’s our problem. It’s an industry-wide problem and honestly, everyone has a strong point.
He said that instead of HMOs, healthcare providers should instead direct their appeal to private companies to raise their premium. “But like my people say when you pull the leg out of something, the whole body will follow. So maybe they’re pushing us to say we’re sending you HMOs to your bosses – we need you to revise those rates because things are really bad.
A source at NHIS, who begged for anonymity because he is not authorized to speak, said: ‘We will follow up with HCPAN. They are talking about private health insurance, not government health insurance. Although we also mediate between the HMOs and the Association of Private Healthcare Providers of Nigeria to ensure that contacts are not dropped.
“We are already doing a lot in the area of provider debt collection, and we will ensure that private health insurance policyholders in Nigeria are not left behind. Even today we will be making calls to make sure we nip it in the bud,” the NHIS source said.
By Ojoma Akor (Abuja) & Risikat Ramoni, Lagos
