Prepared from the official page
Complaints about a health insurance company now go to the Insurance Authority: health insurance powers moved to it from the Council of Health Insurance on 4 March 2024. Complaints about a hospital or clinic go to the Council of Health Insurance.
Steps
- Know your rights: the hospital sends the approval request to the insurer within 15 minutes of the treating doctor's request.
- If the approval takes more than 60 minutes, you have the right to the treatment, and the hospital treats it as approved. If you pay cash instead of waiting, you cannot get that money back from the hospital.
- Covered treatment that costs less than SAR 500 needs no approval. In an emergency you get care at once, and the insurer must be told within 24 hours of your arrival.
- You do not have to sign a pledge to pay the claim to the hospital if the insurer does not accept it.
- To complain about the insurer: open the “Complaint against an insurance company” service on the Insurance Authority website, press “Get Started”, then sign in on the official site. Or call toll-free 8001240551.
- Choose “Submit a Complaint”, enter the insurance sector details and the complaint details, upload what supports it, then press “Submit”.
- To complain about a hospital or clinic: use the Council of Health Insurance service “File complaint against service provider”. It takes 10 working days; for help call 19977.
Have ready:
- The insurance sector details for a complaint about the insurer, or the hospital's or clinic's details if the complaint is about it
- Your complaint number with the insurer, if you complained to it
- Papers that support your complaint (if any)
- For a money claim against a hospital: the claim form, the invoices and the medical reports
- Valid health insurance, which the Council requires for a complaint about a hospital