Dear Brothers in Islam.
Assalaamu alaykum.
I would like to thank you for your tireless work, guidance to all the brothers and sisters in Islam and efforts you have vested in the work of Almighty, May Allah provide you the best results for all your efforts - Ameen (Allahhuma Ameen).
I am a medical doctor by profession and I work for a Medical Administrative company in a Capacity of an executive (medical director/Assistant CEO) in the middle east . The company is a service provider providing several services against a set fees:
The role of the medical administration company involves:
Administration of Social Health Insurance mandated by Law (Mandatory Health Insurance) on the behalf of the government/state. (Takaful/Tawunia concept).
Administration of Sponsored medical services by the Public Ministry at various private hospitals. (I.e. Government paying for patients full Payments for Dialysis in private hospital)
Administration of Sponsored medical claims for patients sent for treatment abroad from the Government sponsorship with full payment of all claims as billed.
Administration of Self-Funded Scheme where the employers pay directly all medical claims for employees WITHOUT the involvement of any Insurance policy on the behalf of clients (i.e. medical treatment fully sponsored by various Schools, Universities, Football clubs etc.).
Administration of Medical Insurance policies by processing the medical bills (claims) pertaining to a patient’s medical treatment received from the hospitals from hospital doctors for claiming the treatment amount from the Insurance companies.
Our operation involves:
(a) Providing assistance to patients to avail treatment at several medical hospitals, medical centers, diagnostic centers, pharmacies.
(b) Providing guidance and arranging medical opinions for sick patients under all programs.
© Providing and arranging treatment where serious sick patients are sent abroad by securing direct hospital arrangement for the patients facilitating medical treatment.
(d) Once the patient avails treatment, we receive their bills. We process the bills and convert them into a billable format making the claims easy to be paid to the doctors and the hospitals on the behalf of (employers).
(e) We are a service provider and providing service to all parties, we deal with three partners (Medical doctors, patients/employees, payers (sponsor, employer, and insurer)
(f) We are decision neutral and we make sure that the eligible medical treatment is honored without having any bias towards the profits and losses. Our fee is fixed for consultancy service and is not contingent on any form of ambiguity. Whether the policy burns, or accumulates profit, to us it’s indifferent.
(g) Our roles involve providing extreme clarity to medical doctors and providers on patients eligibility for medical treatment, standards for sending claims to minimize rejections, and processing of claims to submit to payers for settlement.
(h) We are payer neutral.
(i) We provide disease management program (i.e. Maternity, Diabetes, cardiovascular, and Stroke management) on the behalf of payers.
(j) We provide case management for long term hospitalized patients with multidisciplinary hospital teams to access and validate the medical ethical and evidence based approach on the behalf of the payers.
(k) We conduct seminars on recent epidemics, diseases and preventive measure adaptability for our patients on the behalf of payers.
I think if you allow, I should humbly raise this discussion to the next level of discourse. What is of crucial significance is listed below?
(a) We are not an Insurance Company.
(b) We are not a Financial Institution, Broker, or a Bank.
© We are a registered entity by law to provide third party administration - TPA services to all companies for administration of medical/social benefits.
(d) By law our operation has nothing to do with the selling of Insurance, premiums collection, premiums computation, risk taking, reviewing loss and profit, premium settlements, policy renewals, additions or deletion. (we do not charge any money from patients against any promised benefits)
(e) By law we are forbidden to market any Insurance policy of any sort or product in the market.
(f) By law we have nothing to do with the Bank loans, Riba based transactions, signing or witnessing commercial premium based insurance contracts, preparing documents for Riba transactions, calling people towards the purchase of policies or drafting an Insurance agreement.
(g) By law we are not involved in any form of Insurance product designing, policy underwriting or risk adjustments.
(h) All of the above activities are prohibited for our operation.
(i) There is no element of Qimar, Gharar, Usury, or Riba in any of our operations/dealings and transactions.
In reference to the above our fee is based on a fixed amount per patient per year, or per member per year, or on the value of the claims received from the hospitals.
Therefore, I would like to seek your humble opinion on the activity of the TPA and its permissibility in Islam.
There are few factors we must consider:
(1) We are living in a country where Social Health Insurance is Mandatory by Law.
(2) All the employers pay for all the employees for health benefits.
(3) And there is an established consensus that since we are a service provider therefore working in a medical TPA is permissible. Also, there is a very limited understanding of this operation at the global level and that is the reason mostly people confuse the TPA activity and relate it to Insurance Activity which is not the case.
I would really appreciate it if you could shed some light on the above and share your view
Jazak Allah Khyr Al Jaza