Insured Georgians being forced to depend on emergency 112 services for help instead of the insurance companies they pay monthly

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The FINANCIAL — Georgia ranks third in terms of the number of people infected with Covid-19 per 100,000 citizens. As of 16 December, the list is as follows: Serbia; Lithuania; Georgia; Luxembourg; Croatia; Montenegro; Liechtenstein; and the United States of America. Georgian insurance companies have refused to provide information to The FINANCIAL about what services they are giving their Covid-infected patients and why they are providing incomplete services to some of their paying customers.

According to a programme which started on 2 December in Georgia, and ran until 1 February, the state has been conducting about 20,000 Covid tests a day, said Georgian Prime Minister, Giorgi Gakharia. Even in such circumstances, Georgian insurance companies are only covering the cost of a Covid test in exceptional cases. The cost of a test ranges from GEL 110 (USD 34) to GEL 220 (USD 67).

The number of people infected with Covid-19 is still very high in Georgia. A large number of those affected need help from their insurance companies (for which they pay monthly), but are instead having to depend on 112 (emergency) services, a service which is currently extremely over-stretched. In fact, it can often take days to get help from 112.

While on one side there’s the state and the insurance companies, on the other side there is no one to protect the patient. The World Health Organization’s conclusion is that no one is overseeing the complaints of patients in Georgia because there is no monitoring mechanism nor control body for that.

A question therefore arises – if a 112 doctor is able to come and examine a patient with the appropriate personal protective equipment, why can’t one of the insurance companies’ doctors do the same? What has been the response given by the insurance companies to excuse the incomplete services they are providing their Covid-infected patients?

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Insurance companies in Georgia say that according to state regulations they do not have the right to visit the insured in the event of someone displaying Covid-19 symptoms (as opposed to 112 doctors) and therefore they can only provide services over the phone. The FINANCIAL has not been able to find any such regulation however, after searching for the above-mentioned information on the website of the Ministry of Healthcare. No specific, defined regulation has been placed or is available to fully confirm the legitimacy of the information provided by the insurance companies.

Georgian insurance companies have refrained from providing information to The FINANCIAL on what number of referred patients they’ve had, how much service they rendered in 2020, and what the last year has been like.

Givi, who had Covid-19, has a chronic illness that he was receiving treatment for before he contracted Covid; treatment which his insurance always reimbursed him for, including the cost of the medication and everything else he needed. He is still receiving treatment for the chronic disease after recovering from Covid-19, however now that the chronic disease has worsened because of having had Covid-19, the insurance company is refusing to fund his treatment and medication any longer according to Givi, one of the respondents of The FINANCIAL.

TBC Insurance covers the cost of the Covid test for its policyholders, but only the first time one is required. After recovering from Covid-19, if any medical complications remain with the insured patient as a result of having contracted the virus, then they won’t be treated with insurance funding. TBC Insurance also states that their insurance medics will visit a patient on the spot in the event of Covid symptoms, but only to administer first aid.

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Alpha insurance company’s emergency doctors’ brigade is not involved in the Covid-19 treatment process, only in the provision of online services. Also, after contracting Covid-19, if any complications remain for the insured patient, their treatment won’t be funded by their insurance, however the test may be funded according to the decision of the family doctor.

Imedi L doctors also won’t visit any patient displaying symptoms. After recovering from Covid, it is up to the individual family doctor to decide whether the following treatment and Covid test will be reimbursed or not.

GPI Holding doctors are prepared to examine a Covid patient, in terms of both administering a test and post-Covid treatment, but these will be reviewed by the family doctor on an individual case by case basis.

“Visiting patients at home will increase the risk of spreading Covid-19 even more. What’s more, they still cannot do anything significant to help with Covid-19 when the patient has only mild symptoms/complaints (loss of taste or smell, fever, headache etc.), nor with the complicated forms or difficulties that can arise for those with chronic diseases (the at-risk group of patients),” Georgian insurance companies say.

“It’s possible that it’s only the insurance companies’ statement that there is some kind of state regulation preventing insured citizens from accessing full services from their insurance doctor,” said the Georgian Government’s hotline to The FINANCIAL. They went on to confirm they have no information on any kind of regulation prescribed by the state about the services of private insurance doctors.

The hotline of the Ministry of Healthcare of Georgia stated that they do not have accurate information about private insurance companies’ services in regard to Covid-19, because it is up to the individual insurance companies to make the policies themselves.

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