NHIF stops Covid-19 bill payout in private hospitals

The National Hospital Insurance Fund (NHIF) will only provide cover for Covid-19 patients admitted to public hospitals, the insurer has said, a decision that is likely to rattle many members amid rising infections.

Peter Kamunyo, the CEO of NHIF, said the fund will only pay rebates on treatment bills incurred by Covid-19 patients at the Kenyatta National Hospital (KNH), Kenyatta University Teaching and Referral Hospital, Mbagathi Hospital and other Health ministry-designated hospitals in the counties.

“We shall support all Covid-19 positive members and their declared beneficiaries who get admitted to the Ministry of Health designated facilities. NHIF shall not be liable for bills incurred in non-MoH designated health facilities,” he said in a circular to all hospitals.

The move by the NHIF piles anxiety among many Covid-19 patients and their households, in the wake of a decision by private insurers to end cover for such patients. The private insurers hold that Covid-19 is a pandemic hence doesn’t qualify for cover. This means that patients have to dig into their pockets to offset accrued bills.

The decision by the NHIF also raises questions on the capacity of public health facilities to cope with the rising number of Covid-19 patients, which hit 18,581 on Tuesday.

Health Secretary Mutahi Kagwe announced 606 additional cases amid projections of a surge in the coming month.

Insurers across the world face a dilemma striking a balance between business survival and serving customers given that epidemics and pandemics are ordinarily excluded from medical covers. The inability to project and to accurately model the magnitude and duration of pandemics makes insurers exclude this from their covers because high claims have the potential to drive them out of business.

The pricing of private hospitals is generally high compared to that of public facilities and this has resulted in conflicts with insurers even before Covid-19.

The Insurance Regulatory Authority recently told the Senate that Covid-19 treatment in private hospitals costs between Sh600,000 and Sh1.2 million in contrast with public facilities where it averages Sh135,000.

The regulator has since allowed private insurers to only cater for bills from government facilities in a bid to cushion them from this high price disparity.

Association of Kenya Insurers chief executive Tom Gichuhi said on the phone yesterday that the rising caseload puts the survival of insurers at risk given the high pricing in private facilities.

“It is one thing to tell insures to pay Covid-19-related claims and completely another thing for these insurers to be able to afford it, especially considering the way the virus is spreading,” he said.