The months-long delays by insurers in paying the claims of physicians and healthcare centers have become one of the serious challenges of the health system for years. This problem, especially with the rising costs of medical equipment and supplies, has placed additional pressure on clinics, offices, and hospitals. In this context, the Supreme Insurance Council, in its latest meeting, emphasized the implementation of a law that obligates insurers to make timely payments of claims and also to pay penalties in case of delays.
Stabilization of Article 38 of the Second Amendment Law
Mohammad Raeeszadeh, President of the Medical System Organization, pointed out the new resolutions of the Supreme Insurance Council, stating: "One of the most important issues raised in the recent meeting was the stabilization of Article 38 of the Second Amendment Law in the contracts of insurance organizations with the medical community." According to this law, insurers are required to pay 40% of claims within a maximum of two weeks after receiving medical documents, and the remaining amount must be settled within a maximum of three months. In case of delays, insurers will be subject to late payment penalties based on the rate related to participation bonds.
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Development of Preventive Services and Support for Heart Surgeons
Alongside the resolution regarding the timely payment of physicians' claims, the Supreme Insurance Council has also addressed the development of preventive dental services. Raeeszadeh explained that these services will be provided free of charge for vulnerable groups such as children under 14 years old, pregnant women, and seniors over 60 years old under insurance coverage. The aim of this resolution is to prevent tooth decay and enhance oral health in these groups.
On the other hand, the reform of payments to heart transplant surgeons has also been one of the key decisions of the Supreme Insurance Council. Raeeszadeh, noting the existence of nearly 2,000 patients on the heart transplant waiting list, announced the need to increase the fees for heart surgeons. According to the new resolution, an appropriate payment for these complex surgeries will be determined, which brings hope for more of these surgeries to be performed.
Provision of Medical Equipment and Rational Prescription of Medications
Raeeszadeh also referred to a resolution regarding the provision of necessary medical equipment for hospitalized patients, stating: "For the first to third income deciles, where services are free, previous supports will remain in place. For other deciles, it has been decided that the necessary medical equipment for patients will be provided under the supervision of hospitals and through hospital pharmacies at approved prices." This decision could help organize the provision of medical equipment and prevent the imposition of unauthorized costs on patients.
Finally, Raeeszadeh emphasized that the reform of the calculation method for the consulting services of general practitioners working in emergency departments has also been carried out to support the status of these physicians. Previously, requests for consultation from general practitioners in emergencies were calculated as visits, but according to the new resolution, these requests will be calculated similarly to requests for consultations from specialist physicians.
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