ASHIA to increase fee-for-service for surgical and medical procedures – says Dr. Onyemaechi
By Chisom Okafor
The Managing Director (MD), Anambra State Health Insurance Agency (ASHIA), Dr. Simeon Onyemaechi says that in order to reflect the current cost realities, the Agency will increase the fee-for-service paid to its accredited healthcare providers (HCPs) for surgical services like Caesarean Section (CS) etc.
He made this announcement during the quarterly meeting with Chief Medical Directors(CMD) and Administrators of ASHIA accredited health providers held at the ASHIA office in Awka.
Dr. Onyemaechi further said that a new fee- for-service rate for other surgical and medical procedures will be deliberated on and circulated on their WhatsApp platform.
The MD expressed his displeasure that despite the Agency operating a digitalized system that allows end-to-end users to send and receive data at the comfort of their homes, some HCPs still hasn’t submitted up-to three months of enrollee encounter forms to the Agency.
He reminded them of their service level agreement which has a clause on non submission of enrollee encounter forms, which states that, the Agency has the right to give any defaulting Hospital either a fine of one hundred thousand naira (N100,000),suspension or delisting of such hospital depending on the magnitude of the offense.
He urged the defaulting HCPs to compile and submit their up-to date enrollee encounter forms on or before the 7th of May 2024 or face the consequences.
Dr Onyemaechi noted that despite the increased capitation and drug expansion which was geared towards eliminating inappropriate out-of-pocket charges on ASHIA enrollees, it has come to his attention that some HCPs still charge enrollees for services and drugs already capitated.
He reiterated on the need for such HCPs to desist from such act or face being delisted from ASHIA. He said that all the increments in ASHIA services is to avoid enrollees being subjected to unnecessary out-of-pocket charge by the Hospitals.
Dr Onyemaechi reiterated that enrollees should not pay more than 10% for drugs and enjoined them to refer enrollees to ASHIA pharmacies if the prescribed medicines are not available at their hospitals.
Speaking on services rendered to enrollees, the MD announced that ASHIA has produced a Standard Medical Treatment Guidelines which will serve as guide on the right treatment process for every medical service rendered to enrollees. He noted that this will help reduce code denial if followed correctly.
The CMDs appreciated the MD for his timely and swift response to their complaints and plight, they pleaded with him to also look into increment of fee-for-service for other surgical procedures.
