Some enrollees of the National Health Insurance Scheme (NHIS) have urged the scheme’s Health Management Organisations (HMOs) to comply with the new tariff payment model to the healthcare providers.
The enrollees gave the advice in an interview with the News Agency of Nigeria (NAN) on Wednesday in Lagos.
NAN recalls that the National Health Insurance Authority (NHIA) had in Feb. 2025 announced a significant upward review of healthcare provider payments, increasing capitation fees by 93 per cent and fee-for-service rates by 378 per cent, effective April 2025.
In a capitation model, healthcare providers get a fixed payment per patient each year, no matter how much care the patient needs, while in the fee-for-service model, providers are paid for each service or treatment they give.
Speaking, an enrollee and staff of the agency who pleaded anonymity, said it was imperative that HMOs comply with the new tariff payment model to save enrollees of embarrassments from the healthcare providers.
The enrollee decried the level of insults he got from the healthcare provider at the Ikeja Medical Centre as a result of failure of his HMO to comply with the new payment model.
He explained that the healthcare provider (Ikeja Medical Centre) was complaining that HMOs were not only failing to comply with the new payment model, as they still used the old payment system, but, they were also owing the hospital about two to three years outstanding bills.
According to him, there is urgent need for the HMOs to start complying with the new payment model by upgrading their tariffs to reflect the present day reality, as cost of drugs, treatment and healthcare services are becoming too expensive.
“I was at the Ikeja Medical Centre to consult with a doctor for my health needs. Unfortunately, I was told by the attendant officer that they don’t attend to Sunu NHIS patients.
“On further inquiries, I made to understand that Sunu, my HMO, not only failed to comply with the new tariff payment model, but, is also owing the hospital two years outstanding bills.
“It was so embarrassing the way this hospital treated me, though, they finally allowed me to consult with the doctor.
“I think the solution is for the HMOs to comply with the new tariff payment model, as they upgrade their tariffs to reflect the present day reality because cost of healthcare is high.
“Similarly, the HMOs should ensure payment of their outstanding bills; owing the healthcare providers two to three years outstanding bills is uncalled-for, as it will make the hospital to run at a loss and equally restrict their services to NHIS enrollees,” the enrollee said.
Contributing, another enrollee of NHIS, Mrs Chinelo Chukwuma, urged the NHIA, to intensify efforts to ensure full implementation and compliance to the new tariff payment model by all HMOs.
According to her, implementation is key to the new tariff payment model for it to have positive impact on the scheme and the enrollees.
Chukwuma, a staff of National Orientation Agency (NOA), called for review of the operations the healthcare providers and HMOs to ensure improvement and quality in their services.
She lamented that the health insurance scheme was full of loopholes, embezzlements and mismanagement, which made it difficult to deliver effectively.
“Adequate allocation of funds and resources to the healthcare providers will enable them to enhance the quality of their service delivery to enrollees,” Chukwuma said.
When contacted, a staff of Sunu Health, a HMO, Mr Godwin Ekanem, frowned at the act of healthcare providers whereby they do not attend to an enrollee simply because his/her HMO failed to comply with the new tariff payment or was owing two years outstanding bills.
Ekanem said the healthcare providers were not supposed to act negatively to any enrollee, but should approach NHIA, which was the regulatory body to make their complain.
“There are channels through which the healthcare providers are supposed to lay their complain and concerns.
“They can approach the HMO directly or go to NHIA, which is the regulatory body to make their complains,” he said(NAN)
