From Fred Ezeh, Abuja
National Health Insurance Authority (NHIA) has decried rising cases of complaints by enrollees of the national health insurance services, who face some delays in obtaining authorisation codes from the Health Management Organisations (HMOs), which allow access to medical care.
NHIA said the unfriendly experience had further affected the trust and confidence of Nigerians in quality access to healthcare services being provided through the health insurance services.
The agency, in a statement by Emma Ononokpono, the acting Director, Media and Public Relations, yesterday, said a directive had been given to all stakeholders on steps aimed at reducing delays in accessing services and ensuring that enrollees receive quality healthcare services.
“NHIA, in fulfilment of its regulatory role to promote patients’ health outcomes by improving efficiency and access to care has taken some steps regarding authorisation of care as were approved at a stakeholders’ meeting in February.
“This has become imperative in view of the notable delay in authorisation of treatment and issuance of codes, which continues to negatively impact beneficiaries’ experience.
“Going forward, authorisation of care and issuance of authorisation codes by HMOs shall no longer exceed one hour from the time of requests by providers. And for all emergency cases, authorisation codes shall not be required before commencing treatment, but shall be obtained within 48 hours of commencing care as stipulated in the operational guidelines.
“Similarly, Health Care Facilities (HCFs) are to promptly submit requests for authorisation codes to HMOs to mitigate service access delays to enrollees. There shall be a communication of a response of ‘no authorisation’ within the one hour period where the HMO has justifiable reasons for not issuing the requested code.
“There shall be a maintenance of records of all requests and responses for treatment authorisation by providers and HMOs, and where delays occur beyond the one-hour timeline, the healthcare provider will be expected to proceed with rendering services to the enrollee, and thereafter, inform NHIA immediately of such services rendered.”
It encouraged enrollees to report any delay or barrier to timely access to health service resulting from receiving authorisation codes in excess of the one-hour limit independently to the NHIA, promising that necessary sanctions shall be applied appropriately to entities deliberately delaying authorisation of care.
The NHIA noted that while the new directive came into operation on April 1, 2025, the authority will regularly review compliance with the revised timeline and provide necessary feedback to stakeholders.