I want to know what recourse do I have if my health insurer refuses to honour my medical expenses on flimsy ground, like overcharging by medical practitioners or hospitals. Also, I fear that from my health insurance premiums are likely to go up drastically because hospitals in the UAE are planning to raise their charges and fees by nearly 50 per cent. What does one do in these circumstances?

This is a very emotive subject, and one that can raise a lot of bad feeling and anger if the situation is not dealt with in the right manner. Regarding the first part of your question you have various means of recourse if you feel you have been unfairly treated, and I will go into those. As to the second part of your query, there are a number of ways to protect yourself from any future increases in medical costs.

If your insurer tries to avoid honouring a claim, you should put your grievance in writing and send it to their claims department, and then work up their chain of command until you get a satisfactory response. If this doesn’t work you should contact the Ministry of Economy who have a complaints department who will assist with your query.

I would like to look at the background of medical insurance and how the plans work here. Medical insurance is essential in a country like the UAE and the GCC in general to cover your medical bills if you become ill or require emergency treatment in the case of an accident.

Medical insurance is part of one’s overall financial planning, and is one of the ‘safety nets’ that need to be in place to protect you from the ‘what if’ situations, along with life insurance and critical illness cover. Much like any form of insurance, you hope not to have to claim upon the policy, but it gives peace of mind to know it is there.

There are many different types of policies that can be tailored to meet your requirements and budget. The major differences that can be seen include the region of coverage, from single country, to region to full international coverage. The level of cover, from in patient only, through to in and out patient coverage, and then there are many add on benefits such as routine dental treatment and maternity cover.

The geographical area of cover you select will generally depend on where you feel comfortable having treatment. You need to consider whether you would want to go for treatment in your home country if you became seriously ill.

The most basic types of medical insurance will only cover you for in-patient treatment only, so this means if you should need to visit the doctors for a minor ailment and need a course of antibiotics, you would be liable for the cost. If you include out-patient treatment as well, then this type of treatment will be covered. This will cause the premium you pay to increase as statistically you are much more likely to need to claim for this type of situation than a more serious illness or injury that requires admission to a hospital.

Extra benefits such as routine maternity cover and dental treatment can be added to a policy for a higher premium. Again the reason for the additional cost, is that if these benefits are included, then it has been proven that claims will be made for these options, and so will drive up the cost of the cover.

By now you have probably realised that for comprehensive medical cover, you will have to pay for the cover. This is one of the realities of residing in a country where there is little or no public health service available to expatriates, you will have to pay to obtain the cover you require. The flip side is of course, you can choose exactly what cover you need and only pay for that, rather than paying income tax.

It is also worth remembering that the medical insurance providers, hospitals and clinics are all trying to make a profit, as they are businesses, so the agenda is different to a public funded system. Again this is not necessarily a bad thing, indeed it can be very good but you need to be aware of this.

This actually relates to both of your points, about overcharging and increases. While the hospital or clinic would like to charge you as much as they can, the medical insurance provider wants to pay as little as possible, and indeed will generally negotiate group rates that will reduce the rates, which can then be passed on to the consumer. This is also why medical providers have networks, as they have agreed prices for treatment with those establishments. Therefore if hospitals do want to increase prices by 50% it is likely they would be removed from insurance providers networks and so lose a large amount of revenue.

So while it is possible that hospitals and clinics will increase their charges any increases are likely to be small. To avoid being overcharged, stay within the networks of your insurance provider, and if your insurance provider’s  premiums increase dramatically, look around at other options with a different provider, as there are a wide range of products available in the market.

What seems to be a relatively simple product is actually very complicated and needs to be thoroughly investigated to make sure the right product is selected.