Dubai: Can hospital refuse emergency treatment if patient lacks insurance coverage?

Question: My baby has a basic health insurance plan, but I often worry about emergencies. There is a hospital near our home that is not covered under his policy. In a medical emergency, can the hospital refuse to treat him because his insurance? This is just for my awareness.

Answer: In a medical emergency, the insurance company must cover the cost of treatment even if the hospital is outside the insurer’s approved network. The insurer cannot deny payment simply because the hospital is “out of network.”

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Their obligation continues until the patient is stabilised and no longer in danger. This is in accordance with Article 13 (2) of the Law No. (11) of 2013 Concerning Health Insurance in the Emirate of Dubai (the “Dubai Health Insurance Law”. “An Insurance company must:

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2. pay the cost of the health benefits provided by a health service provider that is not part of the health service provider network in an emergency case until the beneficiary’s life is no longer threatened.”

Furthermore, medical service providers are obligated to immediately provide medical services to any patient, regardless of whether the patient’s insurance is accepted. Medical services providers cannot refuse emergency treatment due to insurance network issues. This is in accordance with Article 15 (7) of the Dubai Health Insurance Law.

“A health service provider must:

7. Without prejudice to his right to have recourse against the coverage provider for payment of the cost of the health services, provide medical services to beneficiaries in emergency cases until the beneficiary’s life is no longer threatened, even if he is not part of the health service provider network.”

Based on the aforementioned provision of the law, all medical service providers in Dubai are required to provide emergency treatment whenever a patient’s life or health is under threat or in the event of a medical emergency. The insurer remains responsible for covering the cost in accordance with the policy. If emergency care is denied in such circumstances, you have the right to report the incident to the Dubai Health Authority.

Ashish Mehta is the founder and Managing Partner of Ashish Mehta & Associates. He is qualified to practise law in Dubai, the United Kingdom and India. Full details of his firm on: www.amalawyers.com. Readers may e-mail their questions to: news@khaleejtimes.com or send them to Legal View, Khaleej Times, PO Box 11243, Dubai.