True-Doctor
Getting paid by insurers in Uganda
Most claims that are paid late, or not at all, were lost at the desk on the day of the visit, not at the insurer. The fix is a routine that starts before the patient is seen.
Know each contract
For every insurer you work with, keep the signed contract, the agreed tariff, what needs approval first, and the deadline for sending claims. Put the deadline where the person who sends claims will see it.
At the desk, before the patient is seen
- Check the member card and an ID, and that the cover is active today.
- Check what the scheme covers and its limits for this kind of visit.
- Get approval before admissions, procedures and anything over the limit. Write the approval number on the visit.
A complete claim
Insurers query claims that are missing something. Each claim should carry:
- The member's details exactly as on the card.
- The diagnosis, written clearly.
- Every service, test and medicine, at the agreed tariff.
- The approval number where one was needed.
- The patient's signature, and the clinician's.
Send on time, then track every claim
Send claims in a weekly batch, well inside each insurer's deadline. Then track every claim through submitted, queried, approved and paid.
Answer queries within days. A claim with no decision after 45 days needs a phone call, not another week of waiting.
Reconcile what is paid
When money arrives, match the insurer's remittance advice against your claims, line by line. Write down every shortfall and its reason, and dispute the ones that are wrong. If an insurer does not resolve a complaint, the Insurance Regulatory Authority of Uganda handles complaints about insurers.