No patient should wait beyond one hour, regulator warns HMOs

Health Maintenance Organisations in Nigeria have been warned not to delay patients on health insurance plan more than one hour before receiving medical attention at their chosen healthcare facility.

This was disclosed by the Managing Director and CEO of Ultimate Health Management Services, Otunba Lekan Ewenla, during the firm’s 14th Annual General Meeting held in Abuja on Thursday.

Ewenla, a former governing council member of the National Health Insurance Scheme, revealed that the mandate came from the National Health Insurance Authority following a spike in complaints from enrollees about prolonged delays and neglect at health facilities.

“Too often, patients spend the entire day at hospitals before being seen. This is unacceptable. The NHIA has now directed that the maximum waiting time for any patient under the health insurance scheme must not exceed one hour,” Ewenla said.

He likened the NHIA’s role in the health sector to the regulatory functions of the Central Bank of Nigeria in banking and PENCOM in pensions, emphasizing its responsibility to enforce standards, monitor providers, and protect patient rights.

Reacting swiftly to the NHIA directive, Ultimate Health Management Services says it has not only complied but has surpassed the benchmark.

“Today, our average waiting time is just 10 minutes, and we are working to reduce it further to five minutes,” Ewenla said.

To achieve this, the firm has deployed robust health management software and introduced a pre-booking system, allowing patients to notify the HMO in advance of their intended hospital visit. The HMO then contacts the hospital to prepare for the patient’s arrival.

“We even place reminder calls to the hospital on the morning of the patient’s visit. This is in line with global best practices. Healthcare should not be approached casually,” he said.

Ewenla stressed that quality healthcare is a fundamental right, and health insurance is the gateway to accessing that right effectively.

In what he described as a strategic move, the health expert disclosed that Ultimate HMO has launched an initiative targeting Nigerians in the diaspora who wish to support the medical needs of their ageing parents and loved ones back home.

Many Nigerians abroad send money back home for healthcare, but this one-off approach often fails due to lack of follow-up care,” Ewenla explained.

“We’ve created a system that allows diaspora Nigerians to pay a fixed premium and enroll their dependents in a structured health insurance plan.”

The pilot has already begun in the United States, where Ewenla recently held talks with the Nigerian Consulate in Atlanta, Georgia.

The outreach has extended to Nigerian-run churches, mosques, and grocery stores.

“We’re seeing growing interest from the diaspora, and we are pushing for regulatory backing to ensure wider enrollment and compliance,” he said.

Ewenla, however, noted that attitudinal change among Nigerians remains critical to success, citing a general lack of respect for systems and rules.

“We all see how Nigerians disregard simple traffic laws. The same attitude reflects in how we treat healthcare systems. That’s why we’re working closely with the government and regulatory bodies to change this narrative,” he added.

Also speaking at the AGM, the Board Chairman of Ultimate Health Management Services, Mrs. Angela Ajala, emphasized the need for HMOs to prioritize patient welfare and warned against the growing trend of delayed claims settlements by some organisations.

“We take the health and satisfaction of our enrollees very seriously. At Ultimate HMO, we ensure prompt settlement of claims because that’s the backbone of our service delivery,” Ajala said.

She urged stakeholders in the healthcare sector to embrace innovation and adapt to emerging challenges, including the rise in mental health needs, telemedicine, and care for children with special needs.

We must be proactive. The expectations of patients are evolving, and we must think ahead to remain relevant,” she concluded.