Thousands of patients accredited to the National Hospital Insurance Fund (NHIF) risk missing critical medication after several health facilities threatened to halt services due to the national health insurer’s failure to remit monthly payments.
The Nation Saturday learnt that a number of health facilities across the country, especially private ones, had put their patients accredited to NHIF on notice, asking them to offset their medical bills as the insurer had defaulted in remitting payments.
The hospitals also warned they will not accept NHIF cards starting tomorrow (Monday) until the fund clears the outstanding payments running into millions of shillings.
One such patient, Sabina Okumu, who has been battling kidney failure since last year, received a notice from the Parklands Kidney Centre asking her to clear an outstanding bill of Sh161,500 before she receives further dialysis.
The facility also warned patients using NHIF cards they will be required to pay cash for the services and claim refunds from the insurer.
On Saturday, the NHIF Chief Executive Officer, Geoffrey Mwangi, confirmed he was aware of the threat by hospitals to withhold services from patients using NHIF cards.
However, he downplayed the matter, saying he had already communicated with the concerned hospitals not to turn away patients who use NHIF cards to seek medication as the insurer works round the clock to streamline its remittances.
“I know we have delayed remitting money but I have let the hospitals know we are doing something to address the matter,” he said.
Mr Mwangi then turned the heat on some hospitals which he claimed were inflating bills to steal from NHIF, saying it was the reason they were delaying in making the remittances as they are forced to scrutinise each and every claim to ascertain its authenticity before paying.
“Initially, we would take only 21 days to pay claims but since most of the hospitals want to steal from us, we have set another layer of scrutiny,” Mr Mwangi told the Nation yesterday via phone.
“Some of these claims are fraudulent. I have returned most of them. We are not going to pay them. They are taking advantage.”
Mr Mwangi said the money was meant to pay hospitalisation and not stand-alone services.
“I have a problem with hospitals giving stand-alone services and demanding more money,” he said.
He advised patients to seek services at authorised and genuine health facilities.
“What these people normally do is, they bill us for three dialysis sessions yet they perform only two; they conduct minor surgery yet they want to be paid for major surgeries. We have ethically lost it. We want to take care of sick Kenyans, not individuals with self-interest,” said Mr Mwangi.
An invoice statement seen by the Nation from Parklands Kidney Centre showed that Ms Okumu must clear the Sh161,500 balance before she could access any services.
The bill was incurred between July 18 and August 16.
An official from the hospital yesterday confirmed they have no option but to stop treatment since they have been pushing for payment but with little success.
“The company is left with two choices – either to close down until we are paid or for the patients to pay cash for the services. We are literally on our knees, we do not have money to run the facility,” said the official.
He said starting tomorrow (Monday), patients will have to pay cash and, once the NHIF remits the money, they will be refunded.
“We gave our clients the option of seeking at bigger hospitals. We want them to continue with treatment but not at our facility,” the official said.
The hospital management has also stopped giving credit facilities for drugs and laboratory tests.
“All these are on cash basis because there is no way we can survive on credit.”
The hospital charges Sh9,500 for kidney dialysis.
For Ms Okumu, a mother of two, life has taken a downward spiral since she is not working and her husband is a casual labourer.
“It is terrible, I do not know how I am going to survive. I have been relying on my card for the services because they are very expensive. I need to settle the balance,” she said.
She gets two injections for two dialysis sessions per week.
And she pays Sh4,500 for the tests.
“Apart from paying for the tests, I commute from Mathare North every Wednesday and Saturday to get the services. I am praying that come next week, the insurance will remit money so that we continue with treatment. My life is at stake,” she says.
The cost of treatment for kidney failure is prohibitive. Many patients have died because they could not afford the cost of medication.
It costs Sh60,000 per month to undergo dialysis at Kenyatta National Hospital. The same procedure costs Sh100,000 a month in private city hospitals.
It is recommended that a patient undergoes dialysis three times a week. However, due to high costs, many like Ms Okumu opt to do it twice a week.
A kidney transplant costs up to Sh500,000 at Kenyatta Hospital while it costs not less than Sh1 million in private hospitals.