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Medical aid societies risk lawsuits

by Pamela Shumba
18 Jun 2016 at 10:42hrs | Views
MEDICAL aid societies risk litigation from patients if doctors stop accepting health insurance cards and demand cash upfront with effect from July 1. It is estimated that about 1,2 million Zimbabweans are on medical aid.

The Zimbabwe Medical Association (ZiMA) last month announced that patients will pay cash up front and claim reimbursements from the medical aid societies. The association reiterated that position this week.

The health insurers are allegedly collecting money from clients but are not paying doctors who treat them. Doctors have since resolved not to accept medical aid with effect from July 1, claiming the Zimbabwe Revenue Authority (Zimra) garnishes them for the unpaid claims.

Legal practitioners yesterday said patients had the right to sue medical aid societies if they do not receive the service they are paying for. Mr Matshobane Ncube, a Bulawayo lawyer said patients had the right to seek legal intervention if their agreements with insurers are not serving their purpose.

"If doctors demand cash from patients who have paid money to a medical aid society, it means that the medical aid society is acting in breach of contract with the clients. The clients can therefore sue the medical aid society.

"If patients pay cash to their doctors, they are suffering damages because they have paid the medical aid societies for the service. Essentially this means that the health insurer is not serving its purpose," said Mr Ncube.

Mr Lizwe Jamela, of the Zimbabwe Lawyers for Human Rights (ZLHR) said patients should not be affected by misunderstandings between doctors and medical aid societies.

"What happens between medical aid societies and doctors should not affect patients. The contract between the patients and the medical aid societies should act as insurance and therefore should not be breached.

"Doctors are demanding cash and sending patients back to health insurers for reimbursement because they have no contracts with patients," said Mr Jamela.

Premier Services Medical Aid Society (PSMAS) spokesperson Ms Mavis Gumbo yesterday said their members will not be affected by ZiMA's decision.

"As PSMAS we have doctors that accept our cards. We will continue working with these preferred service providers and I want to promise our members that they will not be affected. We also have the PSMI clinics, where our members receive treatment," said Ms Gumbo.

Sources in the medical fraternity who cannot be named for professional reasons yesterday said some doctors were already disassociating themselves from ZiMA's stance.

However, ZiMA president Dr Fortune Nyamande, dismissed the claim, saying the association is the umbrella body for all doctors in private practice. "This is mere malice trying to divert us from the real issues. Ordinarily, we're speaking from a point of consultation as an umbrella body for all doctors in private hospitals.

"The decision that we have made came from our members. The reason being that we want to make our businesses viable," he said. Recently the government threatened to cancel licences for medical aid societies who were not meeting their obligations, giving them a June 30 deadline.

Health and Child Care Deputy Minister Dr Aldrin Musiiwa last month allayed fears among patients, saying the ministry will make sure that medical aid societies pay doctors.

He acknowledged that the health insurers were not paying service providers but said the ministry will not allow patients to be disadvantaged. Since 2008, there has been an impasse between medical aid societies and service providers regarding payment for medical services rendered.

Source - Herald