Healthcare provider can be selected even with insurance


If you get it right, you’ll have to decide whether or not to pay more for health insurance.

The United Arab Emirates is blessed with an abundance of private healthcare providers, including telehealth providers, primary health care centres, and specialist hospitals. It also has a large number of specialists and consultants with international experience.

But how do you select the right physician, clinic, or hospital?

Comprehending the network architecture
In the United Arab Emirates, all health insurance plans offer healthcare providers (hospitals, clinics, laboratories, dentists, and pharmacies) based on a network system. This system indicates which healthcare providers are available for service. The insurance company, or the TPA if the insurance company outsources its claims administration to a third-party  determines the healthcare providers in a network.

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From restricted networks with a limited number of providers to expansive networks with many, network types are classified. The decision is based on the level of prices charged by service providers. Therefore, your health insurance plan may offer treatment at a limited number of providers whose services are less expensive, or it may offer a very broad range of providers, including some of the most expensive hospitals. In addition, networks may specifically exclude the most expensive hospitals or prohibit you from receiving outpatient care there.

If you decide to seek treatment from a provider outside your network, your insurer may not cover the costs, may only pay a specific percentage of the total costs (typically 75% or 80%), may ask you to make a higher co-pay (a percentage you must pay), or may impose a fixed deductible or excess that you must pay.
Therefore, it is important to comprehend your provider network.

Choosing a doctor
After determining which providers are available, the next step is to find a physician who best meets your needs. However, you may not be aware of your needs. In most instances, you should seek out a family doctor, also known as a general practitioner. The physician will conduct an initial evaluation of the patient’s symptoms and either prescribe medication or request additional diagnostic testing in order to reach a diagnosis. Once a diagnosis has been made, the general practitioner may ask you to rest, recommend a few lifestyle or dietary changes, prescribe medication, or refer you to a specialist.

However, what if you believe you know the cause of the problem, such as lower back pain or a potential lung infection? It may be tempting to go directly to an orthopaedic or pulmonary specialist if your insurance company is paying for the visit. This presents you with a few challenges.

First, a specialist will be considerably more costly. Consequently, your share of the cost may be increased. Second, specialists are frequently incentivized to order unnecessary tests and investigations that will cost your insurance company more money. This could eventually impact your employer’s health insurance premium, leading to a reduction in benefits. Thirdly, certain tests carry risks (such as X-rays) and should be avoided if unnecessary.

Personal investigation
Numerous providers of healthcare now list their doctors and specialists on their websites, along with their credentials, areas of expertise, and languages spoken. Whether you choose your own general practitioner or are referred to a specific specialist, you should always research them online.

The “price equals quality” fallacy
Unfortunately, the UAE’s health authorities do not publish rankings or other measures of care quality that would let people choose a provider based on how well they do their job.

Many individuals use the price of services as a criterion, believing that the higher the price, the higher the quality of care provided. This is the myth that “price equals quality.” However, the price may be increased to compensate for “free” valet parking, gourmet food, or opulent décor.

The best method
Almost always (with the obvious exception of emergencies), the best course of action is to consult a general practitioner. This will potentially save you money, almost certainly limit the increase in your employer’s (or personal) insurance premium at renewal, safeguard your scheme’s benefits, and protect you from potentially unnecessary tests.

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