Health

Early payment in emergencies is a “complex” situation

The weekend before Valentine’s Day, Antonio arrived at a clinic in Los Alcarrizos with a very high fever and severe pain in the lower abdomen.

In order to be admitted, his relatives demanded an advance payment of RD$30,000, which was finally dismissed thanks to the fact that his mother had a friendly relationship with some members of the administrative team and her son was able to receive care, without payment for advanced, for the three perforations discovered in his intestine, the result of a parasitic condition not detected in time.

The same Superintendent of Occupational Health and Hazards (Sisalryl), Jesús Feris Iglesias, confessed that on one occasion they were asking him for half a million pesos to serve a relative. His response was to identify himself as a doctor and tell her that a lawsuit for not providing emergency services would be more expensive than the requested deposit.

If doctors Feris Iglesias have agreed on something; the president of the National Association of Private Clinics and Hospitals (Andeclip), Rafael Mena and the president of the Dominican Medical Association (CMD), Senén Caba, is to define as “complex” the resolution of the advance payment to patients to receive services in the emergencies of some private clinics.

Charge is to private, uninsured patients

“One thing is charging insured patients and another is charging private patients. We have told insured patients 80,000 times that we do not charge them in advance. The one who is charged is the private patient,” Mena said when interviewed about it.

He stated that 90% of the patients who come to the clinics are insured patients.

The doctor detailed under what circumstances an insured patient could be required to pay a deposit in advance before being seen by health personnel: “if that patient is insured and that insurance company has a contract with that clinic, the clinic will admitted without having to make payment. If (the ARS) does not have a service contract and (the patient) wants to stay in that clinic, he has to pay a deposit, because it is as if he were a private patient”.

Mena assured that this money, if it is not consumed in the treatments applied to the patient, is returned “because if not, it is a robbery.”

“The situation is complex because the Social Security Law was imposed by financial capital and the financial oligarchy. The clinics have not increased for 20 years and everything in the stores has gone up, food, hygiene products, “said the representative of Andeclip.

“I am not discriminating, but a transportation man cannot be paid the same as a nurse, even with the basic salary, and a nurse cannot be paid the same as a laboratory worker, so when you raise him, he has to raise (the salary) for everyone, and have they paid us since that time? Have they fulfilled their own law? Why the DIDA and the Sisalryl They don’t get into that and say that?”, questioned the specialist.

Andeclip’s request is “that the law be adjusted according to the inflation of the Central Bank, which has never been complied with.”

Seen from the edge of Sisalryl

“It is a business issue between the private clinics and the ARS. Private clinics do not want to fight with the ARS or close their doors because they feed on patients affiliated with the ARS,” said the head of SisalrylJesus Feris Iglesias.

“The main objective of Sisalryl it is to protect the affiliate and we have made three regulations aimed at minimizing the out-of-pocket expense of the affiliates”, said Feris when referring to resolution 156-2008, which prohibits the collection of advance deposit charged to the affiliate; 165-2009, which orders the ARS to recognize emergency medical assistance and 175-2009, which prohibits improper charging by health providers.

Dr. Feris understands that Public health, as the health management body, must establish fines. “It is the only way to stop this practice, which will continue until the ministry puts a cost on that action.”

On behalf of the Sisalrylthe call to patients “to complain to the DIDA and the ARS and denounce this practice so that the ARS, in case they have made the deposit, have to pay it to the patient.”

DIDA has received 128 cases in this management

“During our management we have received 128 cases for improper charges, for deposit or payments above what is established, of which we have closed 136, a figure that exceeds the number of cases received, on the understanding that we have resolved cases inherited from management above and of those, 113 claims have been resolved in favor of social security affiliates,” said the head of the General Directorate of Information and Defense of Social Security Affiliates (DIDA), Carolina Serrata Méndez.

The official called on the Health Risk Administrators (ARS) to comply with resolutions 156-2008 and 175-2009 of the SISALRYL that order the exclusion from their network of medical centers and health service providers that repeatedly engage in this practice, which damages the health and pockets of those affiliated with the Dominican Social Security System (SDSS).

Serrata Méndez warned Health Service Providers (PSS) not to make undue charges to social security affiliates and guarantee them the medical care contemplated in the legal regulations and the resolutions issued by the Superintendency of Health.

Serrata stressed to patients that they have the right to receive reimbursement “just by presenting an invoice or receipt of payment, in their ARS and in case of not being compensated satisfactorily, in the DIDA”.

CMD speaks

The president of the Dominican Medical College, Senén Caba, understands that these charges to patients in emergencies “happen due to the mistrust of a health system in private hands, in the hands of the misnamed Health Risk Administrators (ARS) that begin to gloss the clinics that are as business as they are and in the end the clinics have to cover those expenses”.

“I believe that the State must intervene, people cannot be left to it by virtue of a mercantilist spirit, that people have to pay for medical care from their meager resources when a Security System was approved here more than 20 years ago. Social, precisely, to cover that situation”, highlighted Caba.

“Insurance does not want to pay, they are glossed, that means denying the provider, be it a clinic or doctor, part of the services they provided because they did not cover them or they look for any parakeet to not pay, then the clinic, in that situation, to not lose everything, it is covered”, he continued explaining.

“Here what is privileged are the pecuniary, mercantile aspects and not the need for services that a Dominican demands at a supreme moment such as the affectation of health,” concluded the representative of the doctors.

What does it say Public health?

Upon being consulted, the Minister of Public healthDaniel Rivera, said that a meeting will be held between the three parties: DIDA, Sisalryl and Andeclip to find a solution together.

The minister did not anticipate when this tripartite meeting would be taking place and as Diario Libre confirmed with the participants, they have not yet been called.

On behalf of Andeclip, Dr. Mena understands that the meeting should be held by the National Social Security Council (CNSS), although in his opinion, the one who should chair this council is the Minister of Health and not the Minister of Labor, because the former is the who knows better the reality of clinics and hospitals.

“That’s rice with mango, in Dominican terms,” ​​said Mena, denouncing that neither the clinics nor the ARS have representation in the CNSS. “I have no objection to getting together and looking for a solution to the problem,” he added.

On the other hand, Dr. Feris Iglesias said that “it is not with the Social Security Council that they have to negotiate, it is with the ARS, which are the ones that make contracts with the clinics and it is from them that indexation must be demanded.”

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