As Kenya moves rapidly towards actualization of radical policy changes in health, including a shift to the Social Health Insurance Fund (SHIF) by July 2024, CHAK Member Health Units have expressed profound disappointment over poor handling of medical claims by Medical Administration Kenya Limited (MAKL).

The health facilities have accused MAKL, which handles medical claims for the police, prison officers and teachers, of unfairly rejecting medical claims reimbursements, disinterest in stakeholder engagement and wanting public relations practices.

The CHAK network members expressed their deep frustration during a plenary session at the Annual Health Conference 2024. Delegates at the conference representing hospitals, health centres, dispensaries, churches, church health programmes, Medical Training Colleges and universities from 45 counties condemned MAKL for what they see as blatantly unfair practices in handling medical claims for patients treated in CHAK facilities.

Delegates shared deeply troubling experiences which they said had disadvantaged the firm’s clients as it had become difficult to continue providing services with no guarantee of claims reimbursement.

Key grievances expressed by the CHAK Member Health Units against MAKL included:

• Full payments are rarely made for services rendered. The MHUs added that even the very little money that had come through had been paid very late.
• Engagement and communication with MAKL leadership has been quite difficult. The firm does not respond to emails and calls and where a response is made, it often comes late.
• They accused MAKL of rejecting a disproportionate number of claims without plausible reasons, adding the firm seemed to have set claim rejection targets.
• It was especially difficult for the health facilities to get authorization to admit a patient despite some of the cases being emergencies.
• The requirement to refer patients through the MAKL system had proved difficult to implement.
• Different contracts for health facilities that are at the same level. The MHUs demanded uniform contracts for similar level facilities.
• MAKL has to reapprove payments after the initial approval. During the reapproval process, money is deducted and payments delayed.
• The health facilities also accused MAKL of asking for arbitrary discounts for services rendered to patients, saying this was especially difficult as reimbursed costs were already extremely low.
• Sometimes payments are signed off by MAKL and not paid.
• MAKL was also accused of declining admission extensions for very sick people, even when it was apparent such a person could not be discharged.
  

The CHAK members, while citing limited revenue streams, added that they were inclined to guard the little income they got jealously and called upon MAKL to improve service delivery and respect the agreements signed with the health facilities.

Pointing out that they were at the front line in health service delivery and often had to deal with disappointed and disillusioned MAKL clients, the health facilities said they were faced with the dilemma of saving a life and accepting inadequate reimbursements, which was akin to being stuck between a rock and a hard place. Out of desperation, many clients were opting to pay out of pocket despite having an insurance cover paid for by the Government.

The CHAK MHUs resolved to remain resilient and fight the unfair practices by MAKL. They were adamant that despite the challenges, being people of faith, they would embark on prayers and aggressive lobbying and advocacy to ensure their grievances were heard and addressed. They proposed a multi-tiered approach with incrementally bold steps to ensure the situation was reversed.