Minet Clarifies Situations When Teachers Are Exempted From Paying Consultation Fees
Teachers’ medical service provider, AON MINET, while giving some of the challenges they face, clarified some situations where teachers will not pay ksh. 50 for consultation whenever they seek services from MINET accredited hospitals.
Without knowing, teachers have been paying the ksh. 50 prior to being attended to even in cases where they should not pay it.
MINET CEO Sammy Muthui has stressed on the seven-day rule, threatening to withdraw contracts of facilities that abuse that rule.
According to the rule, teachers who attend a particular hospital with a similar condition within a span of seven days should not pay consultation fees. However, hospitals breech this rule and get money from teachers even minus probing the last time they were there.
According to Muthui, many facilities have been blacklisted and others presently put under investigations for abusing the seven-day rule.
“If a patient is treated for a condition and within seven days returns to the hospital to be cared for over the same ailment, they should not be charged. The member should never be asked to pay out of pocket. But we have had cases where this rule has been breached and patients asked to pay money or turned away. This is fraud and we take it seriously,” he said.
Muthui said as per the capitation agreement they signed with the service providers, health facilities are required to provide quality services to all the teachers without warranting a return to the hospital for primary healthcare, unless for a different diagnosis or a complication.
“In fact, hospitals are not supposed to even discuss the seven-day rule. They are just required to offer services as per the agreement. But we have had to blacklist many facilities for this misbehaviour,” said Muthui.
There are 607 medical service providers available on both direct and referral access.
Muthui, however, said the fraud has been detected in just a small fraction of the health facilities contracted to treat teachers and their dependents.
“We have a small number of service providers that we are already investigating and we are taking disciplinary action against them because they provide poor services that are not impressive under the scheme,” he said.
Muthui said they have embarked on a new system of rating hospitals listed under the scheme and noted that those that will post poor scores will be struck off the roll.
“We pick facilities that are accredited by the government, but it is emerging that somewhere along the way some of them start to provide dismal services,” he said.
“We are talking about public funds and we have a duty to care. We have a legal and investigations department dealing with these. As we speak, many cases are under investigation and dozen others in court,” added Muthui.