The agreement provides for a two-step adjustment in the rate of benefits paid this year. (Credit: Philippe Hage Boutros/L'Orient-Le Jour)
An agreement reached between the Lebanese Order of Physicians and insurers on the cost of medical procedures billed by physicians to the latter was approved on Monday.
Dr. Youssef Bakhache, head of the Lebanese Order of Physicians in Beirut, spoke to L’Orient-Le Jour about the details of this agreement which, according to him, have been negotiated since August 2022.
The agreement was signed between the Order and the five major third-party administrators (TPAs) — the entities that manage claims processing and settlement between insured patients and insurers — Globemed, NextCare, Best Assistance, Medivisa and La Médicale.
These five TPAs account for more than 98 percent of the Lebanese medical insurance market, Bakhache noted. He said a similar agreement will be signed with the Association of Insurance Companies in Lebanon (ACAL) in the coming days.
4% every three years
The agreement provides for a two-step adjustment in the rate of benefits paid this year. These include surgery costs but exclude the cost of hospital care and labs, which are deducted from an insured’s coverage limit.
. From January to August 2023, benefits will be set at a “fresh dollar” amount equal to 75 percent of the amount at which they were set in 2019, when the dollar was worth LL1,507.5
. From Sept. 1 to Dec. 31, 2023, benefits will be 85 percent of the amount set in 2019.
. In 2024, benefits will be worth 100 percent of the 2019 amount.
. In 2025, benefits will increase to 105 percent, which means that a $100 consultation that the physician billed to insurance will be increased to $105.
. In 2028, the amount of the intervention billed to the insurance company will be increased by 4 percent every three years.
For example:
A patient receives a medical intervention from a physician. That intervention is covered by their insurance, and the physician bills $100 to the patient’s insurance company. That amount is deducted from the coverage cap in 2019, meaning the final price will be $75 if billed between Jan. 1 to Aug.31, 2023. If billed between Sept. 1 to Dec. 31, 2023, the final price for that same visit will be $84. The same visit will cost $100 if billed in 2024, $105 if billed in 2025, and then the price will increase by 4 percent every three years thereafter.
Assaad Mirza, the president of ACAL, announced some of these changes last week. He pointed out that, in 2022, insurers began to pay 50 percent of benefit amounts in “fresh dollars,” the remaining 50 percent in “bank dollars,” always in reference to the prices charged in 2019.
Mirza also announced an increase in premiums, not exceeding 10 percent, in the coming months. The Order of Physicians did not give a more precise timetable.
Negotiations between insurers and physicians were laborious. According to an anonymous source within the Order, insurers wanted to include a disciplinary clause sanctioning doctors with higher fees, which the Order categorically refused.
On Thursday, Mirza said insurers were preparing to negotiate with hospitals, which are demanding a 40 percent increase in benefits — excluding physician fees — which insurers pay when their patient has medical coverage.
This article was originally published in French in L'Orient-Le Jour. Translation by Joelle El Khoury.