Meet Joy, an expectant single mother. Discover how CarePay supports her throughout her pregnancy journey.
Joy signs up for maternity insurance. Onboarded within minutes, she immediately checks her benefits using CarePay’s Member App. She uses the app to find an in-network provider nearby for her first pregnancy check-up.
The approval process for health insurance takes an average of 7 days in Kenya.
At the maternity clinic, Joy's identity and coverage are quickly verified by the clinic’s receptionist through a digital eligibility check. The receptionist submits a pre-authorization request for Joy through the CarePay platform.
CarePay reduces the annual admin cost per member from 25 EUR to 1 EUR.
Using the CarePay platform, Joy's Case Manager reviews and approves her pre-authorization request directly. Joy can now get the check-up she needs with the reassurance that the costs are covered by her insurance.
Currently, it takes at least 3 days to process a pre-auth request in Kenya.
After Joy completes her check-up, the clinic’s cashier submits a claim through the CarePay platform. The claim is processed by a Claim Manager within 3 hours, making sure that both Joy and her provider are paid in a timely manner.
Claims submitted in paper form have an average processing time of 30 days.
Thanks to CarePay's insights dashboard, Joy’s insurer is able to review their payment forecasts in real-time. Confident that all outgoing payments align with their cash flow, Joy’s payment is approved within 24 hours.
It currently takes an average of 60 days for claims to be paid out in Kenya.
Joy tracks her claim history and benefit usage in real-time through the CarePay Member App. After a smooth first experience, Joy finds herself anticipating her future check-ups with increased peace of mind.
CarePay has a Net Promoter Score of 60.
Shifting to an end-to-end, digitised health insurance process was game-changing for us. With CarePay's technology, the number of days between a member's treatment and their claim reimbursement has dropped from 77 to only 3 days! This is one of many improvements that has enabled us to fully control our costs and the end consumer experience.
SMS is a powerful tool in getting COVID-19 messages to Kenyans. It is direct, immediate, and can be integrated with other platforms. At PharmAccess, we are in regular discussions with the Ministry of Health and other healthcare bodies about ways to use the CarePay platform to strengthen our health and emergency response.