With a market size of 34 billion SAR, market experts consider the Saudi private healthcare sector to be one of the largest in the area. Health insurance companies are responsible for 53% of the total annual revenue in this sector and Saudi Arabia’s national transformative strategy plans to gradually grow the market size by more than 141 billion SAR through privatization by 2030.
However, unlike in other global marketplaces, the relationship between providers and payers is not as transparent or standardized. Experts attribute these problems mostly to a lack of sound legal and financial frameworks. Such restrictions have a negative impact on the market’s growth rate as well as the fairness of market dynamics among stakeholders. In addition, the average claim rejection rate for small to medium size healthcare providers is believed to be between 20% and 25%.
Common reasons for medical claim rejections/denials in the Saudi market
- Lack of medical necessity/appropriateness
- Policyholder’s influence
- Low-quality claims documentation
- Non-compliance with regulations
- Technical limitations
- Non-adherence to the payer or national unified medical policies
- Invalid membership
- Exhausted benefits
- Medically harmful services
- Late filing
Glance Care’s team brings to light some of the market’s dynamics, regulators’ rules, challenges, and available solutions in a detailed whitepaper after conducting a 6-month intensive market study. Solutions to the problems highlighted above are also detailed along with easily integratable tools that can help healthcare providers and institutions improve their annual claim revenue turnover and reduce claim rejection rates.
