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teachers medical scheme a scandal?
newfarer
#1 Posted : Friday, April 14, 2017 10:53:33 AM
Rank: Elder


Joined: 3/19/2010
Posts: 3,504
Location: Uganda
https://www.standardmedi...s-under-new-sh15b-cover

have heard various complaints on this scheme.you go to hospital they send you to a clinic called bliss at GPO.you find young chaps who seems not to know what they are doing. then the wait for drugs takes weeks if not months. I see mention of clinix somewhere and then I see a scandal

http://blissgvshealthcare.com/our_clinics.html
this reads like a conduit for making a kill from teachers money

similar to this

https://www.standardmedi...l-hospital-for-its-woes

http://scandalsexposed.weebly.com

http://www.nation.co.ke/...224798-qqxhnd/index.html
punda amecheka
Dahatre
#2 Posted : Saturday, April 15, 2017 11:06:08 AM
Rank: Member


Joined: 12/21/2009
Posts: 602
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..
2012
#3 Posted : Saturday, April 15, 2017 11:13:22 AM
Rank: Elder


Joined: 12/9/2009
Posts: 6,592
Location: Nairobi
Dahatre wrote:
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..


There's no consumer protection in Kenya. If you knew the things Chinese dump in Kenya other than what you already know you'd be disgusted. Sadly, the fake items dumped in Kenya are imported by Kenyans in the name of business, from fake manufactured food stuff to fake batteries etc. The Kenyan consumer is an exploited idiot and our governments have never shown concern.

BBI will solve it
:)
newfarer
#4 Posted : Saturday, April 15, 2017 12:47:50 PM
Rank: Elder


Joined: 3/19/2010
Posts: 3,504
Location: Uganda
and people are quick to rip when the scandal artists die after a long battle with unknown diseases yet they are paying for their evils
punda amecheka
sitaki.kujulikana
#5 Posted : Saturday, April 15, 2017 5:47:24 PM
Rank: Veteran


Joined: 8/25/2012
Posts: 1,826
2012 wrote:
Dahatre wrote:
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..


There's no consumer protection in Kenya. If you knew the things Chinese dump in Kenya other than what you already know you'd be disgusted. Sadly, the fake items dumped in Kenya are imported by Kenyans in the name of business, from fake manufactured food stuff to fake batteries etc. The Kenyan consumer is an exploited idiot and our governments have never shown concern.

I think you are using very strong terms, I don't think we are idiots as consumers, con artists exist everywhere in the world not just kenya. Also remmber not everyone earns 200k plus as you do, and as such at times hakuna option, but to go for what you call fake.
Remember there are con artists, and people have different incomes.
sitaki.kujulikana
#6 Posted : Saturday, April 15, 2017 5:49:26 PM
Rank: Veteran


Joined: 8/25/2012
Posts: 1,826
as for the nhif, and the civil servants medical schemes, they should have stuck to public hospitals, otherwise clinics now have nhif departments, those forms are being filled in proper.
tom_boy
#7 Posted : Saturday, April 15, 2017 6:56:20 PM
Rank: Member


Joined: 2/20/2007
Posts: 767
Dahatre wrote:
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..


Mlifikiria madaktari were on strike for nothing. Sasa ndio tutajuta sisi wote. Nilisema NHIF scheme is a scam. No excuse to put public money into private pockets when there are public hospitals that can do the same job. As we speak hospitals are over quoting for procedures and middlemen are pocketing their cut.
They must find it difficult....... those who have taken authority as the truth, rather than truth as the authority. -G. Massey.
maka
#8 Posted : Saturday, April 15, 2017 7:16:27 PM
Rank: Elder


Joined: 4/22/2010
Posts: 11,522
Location: Nairobi
tom_boy wrote:
Dahatre wrote:
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..


Mlifikiria madaktari were on strike for nothing. Sasa ndio tutajuta sisi wote. Nilisema NHIF scheme is a scam. No excuse to put public money into private pockets when there are public hospitals that can do the same job. As we speak hospitals are over quoting for procedures and middlemen are pocketing their cut.


Something will give way soon watch this space...
possunt quia posse videntur
Bigchick
#9 Posted : Saturday, April 15, 2017 7:17:28 PM
Rank: Elder


Joined: 2/8/2013
Posts: 4,068
Location: At Large.
tom_boy wrote:
Dahatre wrote:
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..


Mlifikiria madaktari were on strike for nothing. Sasa ndio tutajuta sisi wote. Nilisema NHIF scheme is a scam. No excuse to put public money into private pockets when there are public hospitals that can do the same job. As we speak hospitals are over quoting for procedures and middlemen are pocketing their cut.



I want to vouch for nhif and say that maybe what we need is to streamline the procedures and seal loopholes.

My grandma has Cancer of the Oesophagus that was diagnosed in early 2016.We had a stent fitted and the total cost were about 150k.This year the problem resurfaced and we had to have a second stent and guess what all the costs were borne by nhif.At a mission hospital.

I enrolled my house help last year and when she fell ill this year she was treated using the card in a private health facility.I think that the private facilities supplement the public facilities.

Lets work on streamlining the system and ensure as many as possible enroll. The over quoting could be due to the delay it takes to process the payments causing facilities to borrow to sustain their operations.

Love is beautiful and so are those who share it.With Love, Marriage is an amazing event in ones life time, the foundation of joy, happiness and success.
murchr
#10 Posted : Saturday, April 15, 2017 7:52:19 PM
Rank: Elder


Joined: 2/26/2012
Posts: 15,980
A medical scheme that directs you to a certain clinic is a con game, but again, i dont trust sub standard
"There are only two emotions in the market, hope & fear. The problem is you hope when you should fear & fear when you should hope: - Jesse Livermore
.
Dahatre
#11 Posted : Saturday, April 15, 2017 9:12:20 PM
Rank: Member


Joined: 12/21/2009
Posts: 602
Bigchick wrote:
tom_boy wrote:
Dahatre wrote:
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..


Mlifikiria madaktari were on strike for nothing. Sasa ndio tutajuta sisi wote. Nilisema NHIF scheme is a scam. No excuse to put public money into private pockets when there are public hospitals that can do the same job. As we speak hospitals are over quoting for procedures and middlemen are pocketing their cut.



I want to vouch for nhif and say that maybe what we need is to streamline the procedures and seal loopholes.

My grandma has Cancer of the Oesophagus that was diagnosed in early 2016.We had a stent fitted and the total cost were about 150k.This year the problem resurfaced and we had to have a second stent and guess what all the costs were borne by nhif.At a mission hospital.

I enrolled my house help last year and when she fell ill this year she was treated using the card in a private health facility.I think that the private facilities supplement the public facilities.

Lets work on streamlining the system and ensure as many as possible enroll. The over quoting could be due to the delay it takes to process the payments causing facilities to borrow to sustain their operations.


Pole about your Cucu..Glad she is doing better.

When I said herding cats, I meant that it will be almost impossible to streamline the system with so many clinics/hospitals willing to scam people. If on the other hand NHIF funds were to support a single payer, it might be easier to streamline. Private hospitals are in this to make money. They are definitely not subsidizing public facilities.

Never heard of overbilling to compensate for late payments..

tom_boy
#12 Posted : Saturday, April 15, 2017 9:47:20 PM
Rank: Member


Joined: 2/20/2007
Posts: 767
Bigchick wrote:
tom_boy wrote:
Dahatre wrote:
The privatization carnage continues. Many have now learned they can start a clinic/hospital---some (many?) with the intent of scamming clients and or/collecting NHIF and other insurance funds. Insurance companies are already complaining that claims are too high due to billing fraud.

Without consumer protection laws, we will have no recourse and we will pay more for an an even lower quality of care than we have now. Trying to correct this after the fact will be like herding cats.

Tutalilia chooni..


Mlifikiria madaktari were on strike for nothing. Sasa ndio tutajuta sisi wote. Nilisema NHIF scheme is a scam. No excuse to put public money into private pockets when there are public hospitals that can do the same job. As we speak hospitals are over quoting for procedures and middlemen are pocketing their cut.



I want to vouch for nhif and say that maybe what we need is to streamline the procedures and seal loopholes.

My grandma has Cancer of the Oesophagus that was diagnosed in early 2016.We had a stent fitted and the total cost were about 150k.This year the problem resurfaced and we had to have a second stent and guess what all the costs were borne by nhif.At a mission hospital.

I enrolled my house help last year and when she fell ill this year she was treated using the card in a private health facility.I think that the private facilities supplement the public facilities.

Lets work on streamlining the system and ensure as many as possible enroll. The over quoting could be due to the delay it takes to process the payments causing facilities to borrow to sustain their operations.


My point is, NHIF is paying bills but middlemen are eating big. How do you explain NHIF paying an agency then the agency pays the hospital bill for the patient. Believe it or not, its happening and the eating must be big time.
They must find it difficult....... those who have taken authority as the truth, rather than truth as the authority. -G. Massey.
shocks
#13 Posted : Saturday, April 15, 2017 10:30:32 PM
Rank: Member


Joined: 3/15/2009
Posts: 359
murchr[color=red wrote:
]A medical scheme that directs you to a certain clinic is a con game[/color], but again, i dont trust sub standard

That bit is true, my mum told me the same goes on in Nakuru, and the queus are longer than in public hospitals
thuks
#14 Posted : Sunday, April 16, 2017 9:18:31 AM
Rank: Veteran


Joined: 10/8/2008
Posts: 1,575
shocks wrote:
murchr[color=red wrote:
]A medical scheme that directs you to a certain clinic is a con game[/color], but again, i dont trust sub standard

That bit is true, my mum told me the same goes on in Nakuru, and the queus are longer than in public hospitals

For three months, the public facilities (doc?) were pilloried to no end. Few patients want to go there now
I care!
Bigchick
#15 Posted : Sunday, April 16, 2017 12:24:14 PM
Rank: Elder


Joined: 2/8/2013
Posts: 4,068
Location: At Large.
murchr wrote:
A medical scheme that directs you to a certain clinic is a con game, but again, i dont trust sub standard



Not really.

I was once involved in the development of an Insurance/Medical cover for low income people.One of the things that we looked at was the health facilities to work with.This was to take care of quality as well as work as a control measure.It cannot be open to all facilities otherwise even the Mugo Wa Wairimus of this world would benefit.

The considerations were location,size pf facility,population size and there economic profile etc.

One notable observation was that once people especially the lower income get the cover they imagine its a ticket to spending.They would passby the hospitals after church on sunday like an outing to go for general check up.Others would go to the dentist and order for Sensodyne,mouthwash na kadhalika.

This called for the above measures.And which may explain why some agencies have been recruited as well as co-payment in some hospitals.
Love is beautiful and so are those who share it.With Love, Marriage is an amazing event in ones life time, the foundation of joy, happiness and success.
murchr
#16 Posted : Monday, April 17, 2017 11:25:22 PM
Rank: Elder


Joined: 2/26/2012
Posts: 15,980
Bigchick wrote:
murchr wrote:
A medical scheme that directs you to a certain clinic is a con game, but again, i dont trust sub standard



Not really.

I was once involved in the development of an Insurance/Medical cover for low income people.One of the things that we looked at was the health facilities to work with.This was to take care of quality as well as work as a control measure.It cannot be open to all facilities otherwise even the Mugo Wa Wairimus of this world would benefit.

The considerations were location,size pf facility,population size and there economic profile etc.

One notable observation was that once people especially the lower income get the cover they imagine its a ticket to spending.They would passby the hospitals after church on sunday like an outing to go for general check up.Others would go to the dentist and order for Sensodyne,mouthwash na kadhalika.

This called for the above measures.And which may explain why some agencies have been recruited as well as co-payment in some hospitals.



I get you @Bigchick, but from the story, this one tells you to go to a specific(maybe i should have used this word rather than certain) clinic. I understand there are "in network" hospitals/clinics/doctors/ambulances etc but at the end of it all, you should be able to choose from a variety, not one working in some top floor in town.
"There are only two emotions in the market, hope & fear. The problem is you hope when you should fear & fear when you should hope: - Jesse Livermore
.
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