NHIA reluntant as Nigerians groan over near-death experiences with HMOs

Several Nigerians have narrated what they described as life-threatening experiences while accessing healthcare through Health Maintenance Organisations (HMOs), accusing hospitals, medical personnel and HMO providers of shifting responsibility while patients endure delays in receiving medical attention.

Blueprint.ng investigations independently verified many of the complaints through firsthand observations at accredited hospitals and interviews with HMO enrollees, revealing delays in treatment approvals, bureaucratic bottlenecks and poor patient handling.

The complaints, shared on X (formerly Twitter), have reignited concerns over the quality of healthcare services available to HMO enrollees, with many alleging delayed treatment, poor attention and bureaucratic processes that they say have endangered lives.

The debate was sparked by a post from Foundational Nupe Lawyer (@egi_nupe), who recounted losing his son after a hospital allegedly delayed referring him to another facility while awaiting approval from his HMO provider.

“I stopped taking HMO serious when one hospital in Lekki was waiting for approval from my HMO company to refer my late son to another hospital. Even when I categorically told them that I was ready to pay in full if the approval would delay,” he wrote.

His account triggered hundreds of reactions from Nigerians who shared similar experiences, with many blaming both hospitals and HMO operators for delays in treatment.

One of the respondents, identified as Midnight Counsel on x(@jamiuijaodolaa), said he was once left unattended for hours while other patients who arrived after him were attended to first because he was using an HMO.

“That particular day, I was literally the last person to be attended to. People who came in after me were seeing the doctor before me, and I just kept calm because I knew I wasn’t paying directly for the service,” he wrote.

He added that HMO enrollees should not be treated as though they were receiving free or inferior healthcare.

“If you’re covered by HMO, you shouldn’t be made to feel like you’re receiving free or inferior healthcare simply because you’re using it. The treatment should be the same.”

Another X user, Olajẹtẹmi (@OlasunkanmiH…), alleged that hospitals often become less responsive once they discover a patient is enrolled under an HMO.

“My mum’s HMO is St. Nicholas Hospital. I’ve followed her there twice and the way they do to them, obviously they’re not always happy when they know you’re using HMO. Believe me, the medical attention, care and service won’t be 100 per cent for an HMO patient,” he claimed.

However, a former HMO employee, Sen. BABS (@Babshub_), argued that hospitals should shoulder much of the blame, alleging that approvals are often granted on time but patients are told otherwise.

“I worked in HMO, and 90 per cent of the time the hospital staff are lying, or the staff are lazy to do their job. Most times approval has been sent but they delayed attending to patients and hide under ‘Your HMO has not approved.’ Emergencies don’t even need approval,” he wrote.

Also reacting, Olabanji Mikail FISQua (@Africa…), who identified himself as a patient safety consultant, said negligence exists on both sides of the healthcare system.

“As a patient safety consultant, I’m well positioned to help highlight areas of negligence on both sides,” he stated.

The differing accounts have exposed what many described as a persistent blame game among hospitals, doctors and HMO providers, with patients often caught in the middle during critical medical situations.

Some respondents called for stricter regulation of the sector, insisting that healthcare providers should prioritise emergency care over administrative procedures, while HMO operators should ensure prompt authorisation of treatment.

Blueprint investigation

Blueprint investigations revealed that delays in accessing healthcare through Health Maintenance Organisations (HMOs) are not limited to complaints on social media.

Blueprint.ng correspondent observed that obtaining treatment through some HMO providers could take several hours and, in some cases, more than a day before approval was received. Hospitals often attributed the delays to difficulties accessing HMO portals, server downtime or pending treatment authorisation from HMO providers.

In some facilities, Blueprint.ng also observed what patients described as the lackadaisical attitude of some hospital personnel while awaiting approvals, with patients left unattended for prolonged periods.

One HMO enrollee,Mrs Bolaji Dere who spoke with Blueprint, said she decided not to renew her health plan after repeatedly experiencing delays at a designated hospital in Kwara State.

“My children enrolled me in the HMO scheme, but each time I visited one of the hospitals for treatment, I was delayed and eventually asked to return the following day,” she said.

“When I returned the next day, they were surprised that I came back. When they finally attended to me, they told me I would have to buy my drugs. I reminded them that my high blood pressure medication was covered under the HMO. It took the intervention of another doctor before I eventually received treatment.

“The hospitals and even the HMOs are notorious for this in Kwara. The next time I became ill, I told my children not to renew my HMO plan. I would rather use the money myself to pay for treatment. The situation is worrisome.”

Similarly, Blueprint.ng observed repeated delays during several visits by its correspondent to one of the accredited hospitals in Kaduna State. On each occasion, hospital officials said they were awaiting approval or confirmation from the HMO provider before treatment could commence.

The delays, in some instances, forced the correspondent to leave the hospital without receiving treatment and seek medical attention elsewhere at personal expense.

When contacted, one of the HMO providers used by the Blueprint.ng correspondent acknowledged the delay and apologised for the late response.

The HMO official advised the correspondent to instruct the medical facility to forward an email requesting treatment authorisation, after which the necessary approval would be processed.

Despite the growing complaints from patients and the findings of Blueprint.ng ’s investigation, the National Health Insurance Authority (NHIA), the Federal Ministry of Health and Social Welfare, and other relevant regulatory agencies had yet to issue any official response as of the time of filing this report.