Insurance Confusion

The FINANCIAL — There is the notion in Georgia that doctors aren’t attentive enough to patients that have insurance.

The FINANCIAL — There is the notion in Georgia that doctors aren’t attentive enough to patients that have insurance. 

Medical practices accuse insurance companies of being late in providing payment. On the other hand though, insurance companies blame the clinics for not providing the insurance companies with all the documents that they require in an reasonable amount of time, therefore delaying the payment transfer process.

“If the insurance company serves the clinic well and has a good payment system, then the clinic serves the insured patient properly. However if the insurance company has some problems with the clinic, then its doctors will put off treating its insured patients,” said Giorgi Gigolashvili, President of the Insurance Institute of Georgia. “Doctors complicate the treatment procedures for such patients. For example, they might force the patient to wait in a queue unnecessarily,” he added.

“I admit that the financial service of the insurance companies is not regulated. Payment is not generally made on time,” said Irina Dumbadze, Relationship Manager with Insurance Companies at Caraps Medline. “But that does not mean that the clinic makes any difference in the treatment process of its patients whether or not they are insured. Moreover, we may actually pay more attention to our insured patients as we have an agreement with the insurance company which means that we are somehow more obliged to treat them well,” she added.

“As a doctor, I cannot advise patients on which insurance company is better as health insurance policy is almost the same at every insurance company,” said Lia Chkheidze, family doctor at Antropos. “Also, when a clinic is cooperating with several insurance companies, it is unethical from our side to name the best ones. None of the problems between the clinics and insurance companies have any influence on the treatment process of the patients,” she added.

“My grandfather needed an emergency operation,” said Beso Machaidze, insured at GPI Holding. “He was insured at GPI Holding. We asked permission from the insurance company to do the operation, and they did everything to extend the process. Despite the fact that doctors at Aramiantsi hospital knew it was an emergency situation, they refused to operate until they received confirmation from the insurance company. In the end my grandfather died as the operation he so desperately needed was done too late,” said Beso Machaidze.

Machaidze is not the only client to have been the victim of a misunderstanding between insurance companies and clinics in the country. The insurance companies respond to such customers that, out of so many insured people it’s not surprising that some of them are dissatisfied. The insurance companies however, are disturbed by the fact that insured clients complain about receiving bad service in the clinics. They don’t think that the carelessness of doctors is the fault of the insurer. “The employer of a contractor clinic isn’t the employer of the insurance company. Unfortunately we can’t control their relations with the patients,” this is how insurance companies respond to their client’s complaints.

“I would say that on the contrary – doctors prefer treating insured patient more than uninsured ones,” said Tina Stambolishvili, Head of the Marketing Communications Division of GPI Holding. “The doctors know for sure that the insurance company will reimburse his/her service. The risk that doctors will not get due payment from an uninsured patient is higher than in the case of an insured one,” she added.

“It is very common for doctors to falsify diagnoses of patients to get unlawful compensation from the insurance company. Sometimes doctors prescribe extra medicines as well as they can get some additional profit from doing that, and some doctors even force patients to undergo an additional (unnecessary) course of medical treatment as they know the insurance company will cover the expenses,” Stambolishvili added.

The only reason why an insurance company might be late in making payments is that sometimes clinics do not provide the required documents on time, or else the insurance companies need time to check the documents, claim the insurance companies. “We ask the clinics to provide this information as soon as possible; in such a format that we can easily check. Often the management of the clinic cannot handle the paperwork. Just a short while ago the clinics didn’t even have computers,” Stambolishvili added.

“Based on our own experience our customers are satisfied with the service they get in our provider clinics,” said Natia Gotsadze, Marketing Director at Standard Insurance Georgia. “The insurance company may be late in making payments when the clinics do not provide the documents on time, or the full details of the service provided. Also, if the insurance company finds some faults in the documents provided, then the process of amendment to the original documentation can take time as well,” Gotsadze added.

How to choose the best health insurance package? Before choosing it, every person should first think about exactly what it is that he/she needs, insurance experts advise. Another piece of advice is to ask a broker for help and choose the company or insurance package in line with their recommendations. Visit a familiar doctor and follow his/her advice is the last piece of advice.

Imedi L is the least problematic insurance company for clinics as well as insured patients, according to the research conducted by the Insurance Institute of Georgia. “Imedi L offered good policy conditions and its service was in general satisfactory. As for complaints, people mostly complain about Alfa insurance company,” Gigolashvili added.

“To assess the health insurance packages of different insurance companies, attention should be given to the quality of service and payment system. The service of insurance companies should be comprehensive yet straightforward. Insured patients should not have to stand in queues and should not have problems with documentation,” he added.

Experts claim that all insurance companies offer almost the same health insurance packages. “We can say that there is almost no competition between the companies represented on the market today. In fact the companies provide almost exact copies of eachother’s offers. And the final product offered by the different companies is similar,” said Nino Kobakhidze, Managing Director at Gras Savoye Georgia.

“The reason why the companies copy the offers is that, because of the high level of competition on the market, they will not allow their customer to go to another insurance company as they claim to offer better conditions. If one company offers something additional, other companies will offer the same product automatically. Insurance companies try to win over eachother’s customers and at the same time not lose the loyalty of their existing ones,” said Gigolashvili.

“There is a lack of professional staff on the market. Unfortunately, the insurance business is not taught properly in Georgia. It takes too many years, to earn a customer’s trust, to learn insurance products in detail, to know what to offer to whom. For all these things it is important to have qualified staff,” Kobakhidze said.

The way out of this situation is standardization, according to the representatives of the insurance companies and insurance experts. “The whole system should be controlled according to one standard, which will unite all the insurance companies and the clinics,” experts say.