Doctors have accused insurance companies of overstepping their role, warning that interference in healthcare delivery is putting patients’ lives at risk.

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) says insurers have assumed the role of “chief controllers” of the health system, dictating which hospitals patients can visit, which doctors they can consult, and even what tests and medications they should receive.

KMPDU Secretary-General Dr. Davji Atellah described the trend as “wrong, unethical and illegal,” insisting that patients have the right to choose their hospital and doctor without interference from insurers.

“A patient should not be denied care simply because an insurer wants to save money,” he said.

The union pointed to growing restrictions, including insurers refusing to authorize procedures, delaying payments to hospitals, and blacklisting facilities.

In Eldoret, they noted, a patient at War Memorial Hospital lost their life after delays linked to insurance approvals.

Tensions escalated in recent weeks after at least 12 insurance firms suspended services at Nairobi Hospital, accusing the facility of increasing diagnostic and treatment charges.

The hospital defended the adjustments, citing rising costs of medical and pharmaceutical supplies. With no resolution, patients have had to seek care elsewhere.

Dr. Atellah warned that insurers are becoming bolder, sometimes coordinating to divert patients from top hospitals. “No facility is safe if this appetite for profit continues,” he cautioned.

Reports of similar interference have emerged in Vihiga, Kiambu, and Trans Nzoia counties.

Acknowledging the high cost of healthcare, Dr. Atellah argued that insurers are driven by profit, raising premiums while withholding payments and, in some cases, demanding kickbacks before settling claims.

“These companies owe hospitals millions. Instead of paying up, they blackmail doctors and facilities, threatening to delist them if they speak out,” he said.

KMPDU announced it is compiling complaints from doctors, patients, and hospitals to present to the Insurance Regulatory Authority (IRA) within two weeks and has threatened legal action against companies found culpable.

“As a country, we must demand transparency and accountability. Insurance is meant to protect patients, not to control healthcare for profit,” Atellah stressed.