Dentists halt treatment of NHP patients over unpaid claims backlog

Dentists under the Namibia Dental Association (NDA) have stopped treating patients covered by the Namibia Health Plan (NHP) medical aid due to alleged delays experienced in the payment of claims.

NDA stopped treating NHP medical aid patients effective 25 April. Statistics provided on NHP’s website show that the fund has over 40 468 principal members and 83 048 beneficiaries.

Physiotherapists have expressed similar concerns regarding NHP, the current breakdown in claims processing, and provider reimbursement.

Both the Namibian Society of Physiotherapy (NSP) and NDA cite alleged incompetence and lack of planning by Universal Care, which has taken over as administrator from Medscheme since the beginning of April.

In a letter sent on Friday, and seen by The Namibian, NDA president Johann Archer states that dentists will cease treatment of the NHP members until the backlog of unpaid claims is cleared.

“Once all backlogged claims have been processed and paid, this position might be reconsidered,” he says.

He adds that they will move to encourage patients and employer groups to consider resigning from NHP and move to other funds that have proven to be “trustworthy and reliable”.

Archer further alleges that Universal Care is uninformed about the Namibian market and how providers function.

“Universal rejects claims with little to no explanation and has irrational requests for motivations for basic dental procedures. They have difficulties in benefit checking and uncertainty about the accuracy of benefits confirmed via telephone. These, among other challenges, have resulted in loss of income for practices. Subsequently, it has led to the utilisation of overdraft facilities and delays in payments to creditors, which result in interest charges. Should this be prolonged, practices may need to cut salaries or retrench personnel as cash flow has been impacted significantly,” he states.

He says these challenges experienced with Universal place patients’ lives in jeopardy, as their conditions deteriorate due to poor administrative governance.

“Dental problems can be fatal, and there are dental emergencies. Hence, patients are at risk,” he says.

NHP spokesperson Tunohole Mungoba told The Namibian yesterday that they will only comment after their meeting with the NDA.

“We only received the letter from the Namibia Dental Association on Friday. Hence, we scheduled to meet with them on Monday. We will only be able to give you a comment after our meeting with them,” she said.

According to NHP’s website, Universal Care has taken over to manage care services for NHP, and Medscheme Namibia will continue as the administrator.

NSP chairperson Christiane von der Heiden in a letter says since the transition to Universal Care in April, a high number of claims have failed to be processed, resulting in them not getting paid for services rendered.

“Furthermore, the delays in processing claims are indefinite. We receive misdirected authorisations, including approvals issued to incorrect providers or disciplines. We have also been unable to verify claim status or payment runs due to non-functional communication channels,” she says.

She states that NHP must urgently investigate the current claims processing and payment failures as well as provide them with immediate clarity on outstanding payments.

“They must also restore functional communication channels for providers. Furthermore, ensure that all outstanding claims are processed and paid within a defined and enforceable timeframe. Establish oversight mechanisms to prevent recurrence of such systemic failures,” she says.

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