What to Do When a Hospital Refuses SHA Cover
If a hospital tells you it won’t accept your SHA cover, what happens next depends entirely on whether it’s an emergency or not. For emergency care, the law and SHA’s own enforcement notices are unambiguous: you cannot be turned away. For non-emergency treatment, the picture is genuinely messier — contracts lapse, systems fall behind, and a refusal isn’t always unlawful, even when it’s frustrating. This page walks through both situations and exactly who to call.
If it’s an emergency: you cannot legally be turned away
Access to emergency medical treatment is guaranteed under Article 43(2) of the Constitution of Kenya. In an enforcement notice issued on 1 August 2026, SHA’s Chief Executive Officer, Dr. Mercy Mwangangi, stated that no patient requiring emergency care should be denied, delayed, referred or transferred because they cannot immediately pay, lack benefit confirmation, or have not provided a deposit, advance payment, or financial guarantee. This followed an earlier warning from Health Cabinet Secretary Aden Duale on 10 March 2026, who specifically rejected system downtime or delayed SHA reimbursement as valid reasons for a hospital to turn a patient away.
If a facility cites “the system is down,” “we haven’t been paid by SHA,” or asks for a deposit before treating a genuine emergency, that facility is acting against SHA’s explicit written directive. SHA has stated that providers found violating this face contract enforcement measures — including de-empanelment and termination of their SHA contract — and may face further action from other regulatory bodies.
Insist on treatment first
State clearly that emergency care cannot be conditioned on payment or benefit verification under SHA’s own directive. Do not leave to seek care elsewhere unless the facility is completely unwilling to budge — every minute matters in a real emergency.
Ask for the reason in writing, if you safely can
A written or documented reason for refusal makes any later complaint far easier to act on. If the situation is too urgent to pursue this, don’t delay care to get it — proceed straight to treatment or the next facility.
Report the facility to SHA
Call the SHA toll-free line 147 as soon as possible, with the facility name, date, and details of what happened. This is exactly the kind of case SHA’s enforcement notice is meant to catch.
If it’s not an emergency: check the facility’s status first
Non-emergency refusals are a different situation. SHA runs contracting cycles for healthcare providers, and a facility’s participation can lapse or change for reasons that have nothing to do with denying you specifically:
The facility’s SHA contract may have expired and not yet been renewed under the current contracting cycle.
SHA has made an accredited Health Management Information System (HMIS) mandatory for contracted providers, with the compliance deadline extended to 30 September 2026 — a facility that hasn’t met this yet may be unable to process SHA claims at all.
The facility may genuinely not be contracted for the specific treatment you need, even if it accepts SHA for other services.
Reimbursement delays from SHA to the facility, while not a lawful reason to deny emergency care, are sometimes cited by facilities as a reason for reduced willingness to take on non-emergency SHA cases.
Ask the facility directly
Request a clear answer on whether their SHA contract is currently active, and whether the specific treatment you need falls under it.
Verify independently with SHA
Call SHA’s toll-free line 147 or 0800 720 601 to confirm the facility’s current contracting status yourself, rather than relying only on what front-desk staff tell you.
Consider an alternative facility
If the refusal checks out as legitimate — a genuinely lapsed or incomplete contract — your fastest path is usually a confirmed-active facility rather than waiting for that provider to resolve its status.
Emergency refusal vs. claim rejection: know the difference
This page is about being turned away before or during treatment. If you were already treated and the hospital’s claim for that treatment was later rejected by SHA, that’s a different process entirely, with its own causes and fix — see our guide on why SHA claims get rejected and how to fix them.
FAQ: Hospital Refusing SHA Cover
Can a hospital legally refuse to treat me under SHA in an emergency?
No. Access to emergency medical treatment is a constitutional right under Article 43(2) of the Constitution of Kenya, and SHA’s own August 2026 enforcement notice states no patient requiring emergency care should be denied, delayed, referred or transferred because they cannot pay, lack benefit confirmation, or cannot provide a deposit or guarantee.
Why do some hospitals refuse SHA for non-emergency treatment?
Common reasons include the facility’s SHA contract having lapsed or not yet being renewed, unresolved HMIS (Health Management Information System) certification requirements, reimbursement delays from SHA to the facility, or the specific treatment falling outside what that facility is contracted to offer under SHA.
What should I do if a hospital refuses me emergency care under SHA?
Insist on treatment citing your constitutional right to emergency care, ask for the refusal in writing if possible, and report the facility immediately to SHA via the toll-free line 147. Do not delay seeking care elsewhere if the facility will not budge.
What should I do if a hospital refuses me non-emergency SHA treatment?
Ask the facility directly whether their SHA contract is active and what specifically is not covered. If they cannot or will not clarify, contact SHA via the toll-free line 147 to confirm the facility’s contracting status, and consider an alternative facility that is confirmed active.
Where do I report a hospital that refuses SHA?
Call SHA’s toll-free line, 147, or the toll-free helpline 0800 720 601. For emergency-care refusals specifically, note the date, facility name, and details of the refusal, as SHA has stated it will take contract enforcement action, including de-empanelment, against violating facilities.
Can a hospital lose its SHA contract for refusing patients?
Yes. SHA has stated that healthcare providers found violating the directive against denying emergency care face contract enforcement measures, including de-empanelment and possible termination of their SHA contract, and may face action from other regulatory or enforcement agencies.
