Questions & Answers
My brother had a heart attack and was treated at a hospital. Can the insurance refuse to cover costs?
My brother had a heart attack two weeks ago, and the ambulance took him to the nearest hospital, where the staff and doctors provided excellent care. Unfortunately, the hospital was not covered by his insurance.
After an emergency procedure, they inserted a stent, and he was discharged four days later, with a referral to a hospital that was covered by his insurance.
When we arrived at the referred hospital, the doctor wanted to insert additional stents, as mentioned in the discharge documents.
However, the hospital applied for insurance approval, and the insurance provider rejected the request. When we contacted the insurance company, they insisted that he travel back home to continue his treatment.
However, he is unable to travel due to his condition.
Kindly assist with this matter.
I understand your brother had a medical emergency and is now facing challenges with insurance coverage for ongoing treatment.
I'd like to assure you that you've come to the right place. We can help you address the insurance company's refusal, especially since travel isn't a safe option for your brother right now.
There are legal grounds to challenge their decision, particularly under emergency care and patient rights.
Let's schedule a quick consultation so we can go over the details and advise you on the next steps. We're here to support you and get this resolved.
Get a comprehensive medical report detailing his initial condition, the emergency procedure performed (stent insertion), his condition upon discharge, and the referral to the second hospital, explicitly mentioning the need for further stents.
Send a formal, written complaint via email and registered mail to the insurance company's complaints department.
Clearly state the situation: the emergency treatment, the referral for necessary follow-up treatment, the doctor's recommendation for additional stents, and the doctor's explicit opinion that your brother is currently unfit to travel.
Demand a written explanation for their denial of coverage and their insistence on international travel despite his medical condition.
If they are not willing to cooperate, we have to file a complaint with the insurance regulatory authority.
We will let you know the possibilities in detail. Kindly share your WhatsApp number to discuss further.
Dear Questioner,
Thank you for reaching out, and I’m very sorry to hear about your brother’s condition. I hope he is recovering well.
Regarding your inquiry:
Emergency Treatment
– Under UAE law, insurance companies are required to cover emergency medical cases, even if the hospital is outside the approved network. You may have the right to claim reimbursement for the initial emergency treatment.
Refused Approval for Further Treatment
– If the insurance company rejected approval for the required stents, despite a clear medical need and referral, this may be considered unjustified refusal, especially if the patient is unfit to travel.
Next Steps
You can file a formal complaint with the Health Authority (DHA in Dubai or DOH in Abu Dhabi) against the insurance company.
Include the medical reports, rejection letter, and doctor’s statement confirming that travel is not possible.
I can assist you with drafting and submitting the complaint and following up with the relevant authority to ensure your brother gets the treatment he needs.
Please let me know if you'd like to proceed with filing the complaint or if you need help communicating with the insurance provider.
Wishing your brother a speedy recovery.
Best regards,
Mohammed Salah
Legal Consultant
Dear Client,
Thank you for reaching out regarding your brother’s recent medical emergency and the challenges you are facing with his health insurance provider.
Based on the information provided, please note the following from a legal and regulatory perspective in the UAE:
1. Emergency Medical Coverage:
Under UAE law, all licensed health insurance providers are required to cover emergency medical treatment at any licensed hospital, regardless of whether the facility is within the insurer’s network.
This includes the initial stabilization and any life-saving procedures, such as the insertion of a stent following a heart attack.
2. Ongoing Treatment and Patient Transfer:
Once the patient is stabilized, further treatment is typically subject to the insurance policy’s network and approval requirements.
However, if the treating physician certifies that your brother is medically unfit to travel, the insurance company cannot lawfully insist on his transfer or deny coverage for necessary care on that basis.
3. Recommended Actions:
- Obtain a Medical Certificate: Request a formal statement from the attending physician confirming that your brother is currently unfit to travel due to his medical condition.
- Submit a Formal Complaint: File a written complaint with the insurance provider, attaching the medical certificate and referencing the relevant UAE health insurance regulations that mandate emergency coverage and prohibit forced transfer of unstable patients.
- Escalate if Necessary: If the insurer continues to deny coverage, you have the right to escalate the matter to the Dubai Health Authority (DHA) or the Insurance Authority, providing all supporting documentation and correspondence.
4. Documentation:
Please ensure you keep copies of all medical reports, insurance communications, and complaints for your records.
Conclusion:
Your brother’s insurance provider is obligated by UAE law to cover emergency treatment and cannot require him to travel for further care if he is medically unfit.
By following the steps above, you can formally assert your rights and, if necessary, seek regulatory intervention.
Should you require assistance in drafting the complaint or communicating with the relevant authorities, please let us know. We are here to support you throughout this process.
Best regards,
Under UAE law, a patient is entitled to receive emergency treatment even if the hospital is not covered by the insurance, and insurance companies are generally required to cover emergency cases as per the policy terms.
You can appeal the rejection by filing a complaint with the Insurance Authority or the relevant health regulatory body.
Our center specializes in such cases, and you can contact us via WhatsApp for further details and legal support.
Since the insurance company is refusing to cover treatment at the local hospital, you should file a formal complaint with the insurance company, detailing all medical details from the hospital and the treatment process, to request an explanation for the denial.
Review the terms of the insurance policy: You should check the terms of your brother's insurance policy, including details of the approved medical network and the hospitals covered by the policy.
If the insurance company denies coverage based on the fact that the hospital he was transferred to is not within the approved network, you can attempt to negotiate or request a reconsideration based on his emergency medical condition.
Hire a specialized lawyer: If the insurance company continues to refuse coverage or does not offer a settlement, you can seek the assistance of a lawyer specializing in health insurance cases.
The lawyer can provide advice on how to file a lawsuit against the insurance company to obtain the compensation due or cover the treatment.
