Brahim, a cancer patient covered by health insurance, has faced numerous demands for upfront payments at a private clinic in Marrakech. Reports indicate that he was asked to pay as much as 5,000 dirhams prior to being hospitalized, leading to hours of discussions with his family regarding the financial burden. At the age of seventy, Brahim received the life-altering news of his cancer diagnosis approximately two months ago. Initially, he began his treatment at a public hospital but later sought chemotherapy at a private clinic in Marrakech, as reported by bladi.net.
During his first chemotherapy session, the clinic reportedly demanded an advance payment of 4,500 dirhams. Lacking the necessary funds, a family member issued a check, which, according to the family, remains with the clinic. Despite having medical coverage and documentation related to his chronic illness, Brahim's relatives believed they should only be responsible for any remaining out-of-pocket expenses. This situation highlights a broader issue, as the demand for advance payment by certain private clinics has previously prompted intervention from the Ministry of Health.
By early August, Brahim's health had significantly deteriorated, with family members noting a drastic decline in his immune defenses. Upon returning to the same clinic where his primary physician works, he was once again confronted with a demand for an advance payment of 5,000 dirhams prior to his admission and testing. This time, however, the family refused to comply. After several discussions, Brahim was finally admitted without the advance payment and spent four nights in the facility.
Continued Medical Challenges and Payment Disputes
Just two days after his discharge, Brahim's condition worsened again. Upon returning to the clinic, his family claims they were once more asked for the same 5,000 dirhams. Again, they refused, leading to approximately three hours of discussions and the intervention of a clinic official before the patient was admitted without upfront payment. After spending five additional nights at the clinic, another dispute arose regarding billing. The family reported being asked to cover the remaining balance and an additional similar charge. They also noted that the clinic declined to complete a form required by the CNSS for certain consultations and services.
Legal regulations provide crucial clarification on this matter. Article 75 of the _[Law 131.13 regarding the practice of medicine](https://www.sgg.gov.ma/Portals/1/textesconsolides/131_13.pdf)_ states that under the third-party payment system, a clinic cannot demand an upfront cash guarantee, by check, or any other means of payment from an insured patient, except for the actual amount remaining as the patient's responsibility. Moreover, a receipt must be issued for any collected amounts related to the care provided.
The provincial delegate of the Ministry of Health in Marrakech, when questioned, labeled the demand for an advance as "illegal" and reminded patients that they can report difficulties in accessing care and practices they believe contravene regulations. In contrast, private clinics have provided a different perspective. Redouane Semlali, president of their association, argues that the national reference pricing, established in 2006, no longer reflects the actual costs of care. He also claims that clinics may request guarantees in ordinary circumstances to secure their receivables, though he insists that no advance should delay care when a patient's life is at risk.
For Brahim, this ongoing controversy has manifested itself in tangible ways, as his family asserts that financial concerns have repeatedly intruded upon his treatment journey while he battles cancer. His case reignites a sensitive question in Morocco: to what extent can a private clinic condition access to care on the prior payment from a patient who is insured?
