Most residents of the UAE are covered by health insurance, so the majority of patients will choose a clinic that accepts their insurance card. For a new facility, joining the right insurance networks is often as important as the location or the doctors. Yet many clinics treat insurance as something to sort out after opening, and lose months of revenue as a result.
This guide explains how insurance network inclusion, also called empanelment, works for new clinics and medical centres, and how to prepare for it.
What insurance inclusion means
Insurers and third-party administrators (TPAs) maintain networks of approved healthcare providers. When a facility is accepted into a network, the insurer's members can be treated there under their policy, and the facility is paid according to an agreed price list and contract. Each insurer and TPA decides independently which providers to accept, based on its network needs, the facility's services, location and pricing.
When can a new clinic apply?
Insurers generally require a licensed, operating facility with licensed clinicians, so applications are normally submitted once the facility licence has been issued. That does not mean you should wait to prepare. The application file, price list and target insurer list can all be ready before opening, so submissions go out immediately.
Choosing which networks to target
Not every network suits every clinic. The right targets depend on:
- The insurance plans held by patients in your catchment, from basic plans to premium international cover
- Your specialties and pricing position
- Which insurers your competitors work with, and where there are gaps
- The employers and corporate groups near your site
What the application usually includes
- Facility licence and trade licence
- Licences of the medical director and clinical staff
- List of services, specialties and opening hours
- Proposed price list for the services you will offer
- Facility details: location, photographs, equipment and capacity
- Key policies and contact details for claims and pre-approvals
Incomplete or inconsistent files are the most common reason applications stall, so it is worth checking every document before submission.
Contracting and pricing
Once an insurer is interested, the terms are agreed in a provider contract, including the price list, payment terms and pre-approval rules. Pricing should be tested against your financial model: a contract that brings patients but does not cover costs is not a good contract.
Getting claims-ready
Network inclusion is only useful if claims are paid. Facilities need to be registered on the relevant electronic claims platform, such as eClaimLink in Dubai or Shafafiya in Abu Dhabi, and staff need to code and document correctly. High rejection rates are one of the most common causes of cash-flow problems in new clinics.
Common mistakes to avoid
- Starting the process only after opening, with no file prepared
- Applying to every insurer instead of the networks that match your patients
- Accepting price lists without checking them against costs
- Underestimating training on coding, pre-approvals and claims submission
