Pay and Claim or Direct

Billing
Georges Chidiac
Agenda

 Daman Overview

 The Health Insurance Market

 Pay and Claim or Direct Billing

 How will Direct Billing work in your Clinic?

25/06/2014 2
Daman Overview
Daman Overview

The National Health Insurance Company – Daman was founded in 2006 as a first and only
pure health insurance player in UAE.

 Market leader in health insurance in the

United Arab Emirates

 Owned by Abu Dhabi Government (80%) and

Munich Re (20%)

 Headquartered in the city of Abu Dhabi,

branches and service points are located across
the Emirates of Abu Dhabi, Dubai and Sharjah.

 Chairman: Mr. Khaled Al Qubaisi

 CEO: Dr. Michael Bitzer

25/06/2014 4
Daman Overview-Business Statistics-

2.5 19
million million
members received
claims
in 2013

750,000 1,600+
managed calls employees,
in 2013 from 51
nationalities

25/06/2014 5
Daman Overview-Lines of Business-

Basic Enhanced Portfolio Thiqa

433,000

83,000
1.29 Million 724,000
Top-up

25/06/2014 6
Health insurance market
 The health insurance market

25/06/2014 8
Pay and Claim or Direct Billing
 Direct billing provides the patient with more flexibility
when seeking treatment

Pay & Claim Direct Billing

 Patient pays OOP  Patient does not pay OOP (only

 Submits claim form with supporting deductible/Co-pay when applicable)

documents to the payer  Patient is shielded against jumbo claims

 Has a waiting period from 7 to 15 working particularly in IP

days sometimes more to receive the fund  He can contact the payer CSD and seek

 Reimbursement is made following different information about listed providers and

models: e.g. as per actual, as per the physicians

payer published rates, 80% of actuals…  In the event of a patient-provider conflict,

 Patient might be discouraged to visit the the payer can interfere to facilitate the

healthcare provider again delivery of the service.

25/06/2014 10
How will direct billing work in your Clinic?
The Contractual Agreement Governs the Payer-Provider Relation
and sets its Foundation

Product and Policy

administration
Administrative
Protocols
Trading
Terms setting

25/06/2014 12
 How to negotiate your contract?

DHA & HAAD implemented a unified structured communication schema, providing a

centralized health data tracking system.

Dubai Billing Structure HAAD Billing Structure

• Dubai Service List • E&M

• OP: CPT4 12 • OP: CPT4 13

• IP: CPT4 12 (SF) • IP: DRGs

• Dental: American coding • Dental: Canadian coding

• Drug list: DDC • Drug list: HAAD drug list

25/06/2014 13
 Thank you

Georges Chidiac
georges.chidiac@damanhealth.ae
25/06/2014 14