ABU DHABI // A lack of trust between insurance companies and medical professionals is eroding care and undermining treatment for some patients, doctors have said.
Insurers must approve the cost of medical treatments before payments are approved. Although the industry standard is 24 hours for standard approval, and no approval is needed for emergency treatment, many doctors say it can take much longer. Some also say the insurance companies, at times, interfere with clinical decisions.
"The entire healthcare system is undermined by a lot of distrust," said Dr Klaus Kallmayer, the chairman of the German Heart Centre Bremen in Dubai. "The problem is that our patient comes in and we can put our hands on his chest to see if his heart is beating and look into his eyes - but that is about all the insurance company will pay for. It does not matter whether the attending physician is an outstanding specialist with excellent credentials or not.
"The procedures that are ordered are vetted by the insurance company doctors who as a rule have very little or no clinical experience.'
The delay in care while doctors wait for approval from the insurance company can be dangerous in some circumstances. In such situations the doctors will often treat patients and hope that the insurance company will pay, he said.
"When we get the approval it's fine - but if we don't?"
He said many clinics quietly paid for treatments insurance companies reject, but that legally the patient was obliged to pay.
Mr Shankar Chellaram, from Goodwill Insurance Brokers in Dubai, said the purpose of insurance was to provide a safety net for people in situations where they might otherwise become destitute, but this only worked if they were able to stick to a viable business model.
"The concept of insurance works because the outflow has to be less than the inflow. If the outflow is more than the inflow then the insurance company would have to close down, so it makes sense for them to have intelligent checks and balances."
He said that to do this, many companies had a maximum limit on what they were willing to spend on their clients.
Although insurance companies do not dictate how a doctor will treat a patient, they do dictate whether the procedure will be paid for.
"The brokers will call me and ask me not to prescribe a certain medicine because they have not budgeted for it and the patient has crossed his limit," said Dr Dillan Shetty, an ear, nose and throat consultant at Al Amin Medical Centre in Abu Dhabi.
He said the basic insurance policy of many of his patients limited their available medical treatment.
Often compassion will lead the doctors to give those patients free or discounted treatment and whatever free medicine samples are available.
"There are many instances when patients have been running from pillar to post for emergency medical care and it has taken two or three days to get treatment."
The insurance companies say, however, that healthcare providers do not always comply with proper procedures, adding time to the claim.
Dr Kallmayer called on the insurers to give appropriately vetted hospitals pre-approval for funding based on clinical decisions. He said contracts could be closely vetted and withdrawn if necessary. This would provide the necessary checks and balances.
"They have all sorts of doctors in contracts with them. They say, we have looked at you, we have inspected you and your facility but we don't trust you nevertheless. I think once they've inspected an institution and made sure the doctor is qualified and has a good reputation then they have to accept what the doctor does.
"If he deviates wildly from what is generally done then they might look into this, but otherwise they should pay what he thinks is right for the patient. Otherwise it doesn't function."
Dr Jad Aoun, the chief medical officer of Daman, the national insurance company said: "The providers do not follow the rules.
"They wait until the last minute and start rushing us. When we get a cold case, we don't rush to do it. We leave priority to the emergency cases." He said that often the hospital will call to complain and hope that because the patient is standing in front of them they will speed up the process.
Sometimes the doctor has not included all of the relevant data and the insurance company needs more information before it can make a decision, he said.
"Some of the doctors are bothered that we are asking for so much information and say that we should be approving blindly.
"If a doctor knows that his patient has insurance the way he writes his prescription or does his investigation to reach the diagnosis is different. It loosens what is necessary and the bill gets bigger.
"We are the guardians of the money that is being given to us to cover the nationals, so we cannot just accept the paper signed by the doctor."
He said the second opinion that the insurance companies sometimes demanded could provide an alternative for patients who might have not been aware of what other options were available.
"I should pay the real price for the real disease, and it's not about cutting costs. Some cases in medicine are not black and white."
amcmeans@thenational.ae
Married Malala
Malala Yousafzai is enjoying married life, her father said.
The 24-year-old married Pakistan cricket executive Asser Malik last year in a small ceremony in the UK.
Ziauddin Yousafzai told The National his daughter was ‘very happy’ with her husband.
The smuggler
Eldarir had arrived at JFK in January 2020 with three suitcases, containing goods he valued at $300, when he was directed to a search area.
Officers found 41 gold artefacts among the bags, including amulets from a funerary set which prepared the deceased for the afterlife.
Also found was a cartouche of a Ptolemaic king on a relief that was originally part of a royal building or temple.
The largest single group of items found in Eldarir’s cases were 400 shabtis, or figurines.
Khouli conviction
Khouli smuggled items into the US by making false declarations to customs about the country of origin and value of the items.
According to Immigration and Customs Enforcement, he provided “false provenances which stated that [two] Egyptian antiquities were part of a collection assembled by Khouli's father in Israel in the 1960s” when in fact “Khouli acquired the Egyptian antiquities from other dealers”.
He was sentenced to one year of probation, six months of home confinement and 200 hours of community service in 2012 after admitting buying and smuggling Egyptian antiquities, including coffins, funerary boats and limestone figures.
For sale
A number of other items said to come from the collection of Ezeldeen Taha Eldarir are currently or recently for sale.
Their provenance is described in near identical terms as the British Museum shabti: bought from Salahaddin Sirmali, "authenticated and appraised" by Hossen Rashed, then imported to the US in 1948.
- An Egyptian Mummy mask dating from 700BC-30BC, is on offer for £11,807 ($15,275) online by a seller in Mexico
- A coffin lid dating back to 664BC-332BC was offered for sale by a Colorado-based art dealer, with a starting price of $65,000
- A shabti that was on sale through a Chicago-based coin dealer, dating from 1567BC-1085BC, is up for $1,950
NO OTHER LAND
Director: Basel Adra, Yuval Abraham, Rachel Szor, Hamdan Ballal
Stars: Basel Adra, Yuval Abraham
Rating: 3.5/5
What are the GCSE grade equivalents?
- Grade 9 = above an A*
- Grade 8 = between grades A* and A
- Grade 7 = grade A
- Grade 6 = just above a grade B
- Grade 5 = between grades B and C
- Grade 4 = grade C
- Grade 3 = between grades D and E
- Grade 2 = between grades E and F
- Grade 1 = between grades F and G
The specs
AT4 Ultimate, as tested
Engine: 6.2-litre V8
Power: 420hp
Torque: 623Nm
Transmission: 10-speed automatic
Price: From Dh330,800 (Elevation: Dh236,400; AT4: Dh286,800; Denali: Dh345,800)
On sale: Now
Specs
Engine: 51.5kW electric motor
Range: 400km
Power: 134bhp
Torque: 175Nm
Price: From Dh98,800
Available: Now
Skewed figures
In the village of Mevagissey in southwest England the housing stock has doubled in the last century while the number of residents is half the historic high. The village's Neighbourhood Development Plan states that 26% of homes are holiday retreats. Prices are high, averaging around £300,000, £50,000 more than the Cornish average of £250,000. The local average wage is £15,458.
UPI facts
More than 2.2 million Indian tourists arrived in UAE in 2023
More than 3.5 million Indians reside in UAE
Indian tourists can make purchases in UAE using rupee accounts in India through QR-code-based UPI real-time payment systems
Indian residents in UAE can use their non-resident NRO and NRE accounts held in Indian banks linked to a UAE mobile number for UPI transactions
Test
Director: S Sashikanth
Cast: Nayanthara, Siddharth, Meera Jasmine, R Madhavan
Star rating: 2/5
AndhaDhun
Director: Sriram Raghavan
Producer: Matchbox Pictures, Viacom18
Cast: Ayushmann Khurrana, Tabu, Radhika Apte, Anil Dhawan
Rating: 3.5/5
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
How much sugar is in chocolate Easter eggs?
- The 169g Crunchie egg has 15.9g of sugar per 25g serving, working out at around 107g of sugar per egg
- The 190g Maltesers Teasers egg contains 58g of sugar per 100g for the egg and 19.6g of sugar in each of the two Teasers bars that come with it
- The 188g Smarties egg has 113g of sugar per egg and 22.8g in the tube of Smarties it contains
- The Milky Bar white chocolate Egg Hunt Pack contains eight eggs at 7.7g of sugar per egg
- The Cadbury Creme Egg contains 26g of sugar per 40g egg
RACE SCHEDULE
All times UAE ( 4 GMT)
Friday, September 29
First practice: 7am - 8.30am
Second practice: 11am - 12.30pm
Saturday, September 30
Qualifying: 1pm - 2pm
Sunday, October 1
Race: 11am - 1pm
Key facilities
- Olympic-size swimming pool with a split bulkhead for multi-use configurations, including water polo and 50m/25m training lanes
- Premier League-standard football pitch
- 400m Olympic running track
- NBA-spec basketball court with auditorium
- 600-seat auditorium
- Spaces for historical and cultural exploration
- An elevated football field that doubles as a helipad
- Specialist robotics and science laboratories
- AR and VR-enabled learning centres
- Disruption Lab and Research Centre for developing entrepreneurial skills
The National's picks
4.35pm: Tilal Al Khalediah
5.10pm: Continous
5.45pm: Raging Torrent
6.20pm: West Acre
7pm: Flood Zone
7.40pm: Straight No Chaser
8.15pm: Romantic Warrior
8.50pm: Calandogan
9.30pm: Forever Young
Volvo ES90 Specs
Engine: Electric single motor (96kW), twin motor (106kW) and twin motor performance (106kW)
Power: 333hp, 449hp, 680hp
Torque: 480Nm, 670Nm, 870Nm
On sale: Later in 2025 or early 2026, depending on region
Price: Exact regional pricing TBA
The specs
Engine: Four electric motors, one at each wheel
Power: 579hp
Torque: 859Nm
Transmission: Single-speed automatic
Price: From Dh825,900
On sale: Now
Disturbing%20facts%20and%20figures
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Mina Cup winners
Under 12 – Minerva Academy
Under 14 – Unam Pumas
Under 16 – Fursan Hispania
Under 18 – Madenat
The specs: 2019 Subaru Forester
Price, base: Dh105,900 (Premium); Dh115,900 (Sport)
Engine: 2.5-litre four-cylinder
Transmission: Continuously variable transmission
Power: 182hp @ 5,800rpm
Torque: 239Nm @ 4,400rpm
Fuel economy, combined: 8.1L / 100km (estimated)
COMPANY PROFILE
Name: Kumulus Water
Started: 2021
Founders: Iheb Triki and Mohamed Ali Abid
Based: Tunisia
Sector: Water technology
Number of staff: 22
Investment raised: $4 million
At a glance
Global events: Much of the UK’s economic woes were blamed on “increased global uncertainty”, which can be interpreted as the economic impact of the Ukraine war and the uncertainty over Donald Trump’s tariffs.
Growth forecasts: Cut for 2025 from 2 per cent to 1 per cent. The OBR watchdog also estimated inflation will average 3.2 per cent this year
Welfare: Universal credit health element cut by 50 per cent and frozen for new claimants, building on cuts to the disability and incapacity bill set out earlier this month
Spending cuts: Overall day-to day-spending across government cut by £6.1bn in 2029-30
Tax evasion: Steps to crack down on tax evasion to raise “£6.5bn per year” for the public purse
Defence: New high-tech weaponry, upgrading HM Naval Base in Portsmouth
Housing: Housebuilding to reach its highest in 40 years, with planning reforms helping generate an extra £3.4bn for public finances
COMPANY%20PROFILE
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In numbers: PKK’s money network in Europe
Germany: PKK collectors typically bring in $18 million in cash a year – amount has trebled since 2010
Revolutionary tax: Investigators say about $2 million a year raised from ‘tax collection’ around Marseille
Extortion: Gunman convicted in 2023 of demanding $10,000 from Kurdish businessman in Stockholm
Drug trade: PKK income claimed by Turkish anti-drugs force in 2024 to be as high as $500 million a year
Denmark: PKK one of two terrorist groups along with Iranian separatists ASMLA to raise “two-digit million amounts”
Contributions: Hundreds of euros expected from typical Kurdish families and thousands from business owners
TV channel: Kurdish Roj TV accounts frozen and went bankrupt after Denmark fined it more than $1 million over PKK links in 2013
3%20Body%20Problem
%3Cp%3E%3Cstrong%3ECreators%3A%3C%2Fstrong%3E%20David%20Benioff%2C%20D%20B%20Weiss%2C%20Alexander%20Woo%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EStarring%3A%20%3C%2Fstrong%3EBenedict%20Wong%2C%20Jess%20Hong%2C%20Jovan%20Adepo%2C%20Eiza%20Gonzalez%2C%20John%20Bradley%2C%20Alex%20Sharp%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3ERating%3A%3C%2Fstrong%3E%203%2F5%3C%2Fp%3E%0A
BMW%20M4%20Competition
%3Cp%3E%3Cstrong%3EEngine%3A%20%3C%2Fstrong%3E3.0%20twin-turbo%20inline%20six-cylinder%0D%3Cbr%3E%3Cstrong%3ETransmission%3A%3C%2Fstrong%3E%20eight-speed%0D%3Cbr%3E%3Cstrong%3EPower%3A%20%3C%2Fstrong%3E503hp%0D%3Cbr%3E%3Cstrong%3ETorque%3A%3C%2Fstrong%3E%20600Nm%0D%3Cbr%3E%3Cstrong%3EPrice%3A%3C%2Fstrong%3E%20from%20Dh617%2C600%0D%3Cbr%3E%3Cstrong%3EOn%20sale%3A%3C%2Fstrong%3E%20Now%0D%3C%2Fp%3E%0A
The specs
Engine: 2.0-litre 4-cylturbo
Transmission: seven-speed DSG automatic
Power: 242bhp
Torque: 370Nm
Price: Dh136,814
The specs
Engine: 4.0-litre flat-six
Torque: 450Nm at 6,100rpm
Transmission: 7-speed PDK auto or 6-speed manual
Fuel economy, combined: 13.8L/100km
On sale: Available to order now
Book%20Details
%3Cp%3E%3Cem%3EThree%20Centuries%20of%20Travel%20Writing%20by%20Muslim%20Women%3C%2Fem%3E%3Cbr%3E%3Cstrong%3EEditors%3A%20%3C%2Fstrong%3ESiobhan%20Lambert-Hurley%2C%20Daniel%20Majchrowicz%2C%20Sunil%20Sharma%3Cbr%3E%3Cstrong%3EPublisher%3A%20%3C%2Fstrong%3EIndiana%20University%20Press%3B%20532%20pages%3Cbr%3E%3C%2Fp%3E%0A
Fight card
Preliminaries:
Nouredine Samir (UAE) v Sheroz Kholmirzav (UZB); Lucas Porst (SWE) v Ellis Barboza (GBR); Mouhmad Amine Alharar (MAR) v Mohammed Mardi (UAE); Ibrahim Bilal (UAE) v Spyro Besiri (GRE); Aslamjan Ortikov (UZB) v Joshua Ridgwell (GBR)
Main card:
Carlos Prates (BRA) v Dmitry Valent (BLR); Bobirjon Tagiev (UZB) v Valentin Thibaut (FRA); Arthur Meyer (FRA) v Hicham Moujtahid (BEL); Ines Es Salehy (BEL) v Myriame Djedidi (FRA); Craig Coakley (IRE) v Deniz Demirkapu (TUR); Artem Avanesov (ARM) v Badreddine Attif (MAR); Abdulvosid Buranov (RUS) v Akram Hamidi (FRA)
Title card:
Intercontinental Lightweight: Ilyass Habibali (UAE) v Angel Marquez (ESP)
Intercontinental Middleweight: Amine El Moatassime (UAE) v Francesco Iadanza (ITA)
Asian Featherweight: Zakaria El Jamari (UAE) v Phillip Delarmino (PHI)
COMPANY%20PROFILE
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Company%20profile
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