The General Directorate of Information and Defense of Social Security Affiliates (dida) called on Health Service Providers (PSS) to guarantee care for all members of the Family Health Insurance (SFS) of the contributory regime amid the differences between the Health Risk Administrators (ARS), the Dominican Medical Association (cmd) and the Specialized Medical Societies.
The entity, which directs Carolina Serrata, issued a statement in which it considers “that the costs, fees, rates and other elements of disagreement could be resolved with the formation of the National Committee of Professional Fees contemplated in article 173 of Law 87-01, since this is the specialized body of the System that, among other powers, must establish the minimum parameters of the fees for the services of health professionals and technicians and, in this scenario, the necessary periodic reviews would be made to avoid these differences that have become cyclical”.
The entity reminded members that they have the right to file their claims in case they are denied service request reimbursement of expenses incurred based on the coverage established in the Family Health Insurance (SFS) by provision and type of care.
“We advocate that they be honest and review the current ratesthe costs of the procedures, the medical fees, the frequency of use of the services, both on the part of the doctors and Health Providers (PSS) and the Health Risk Administrators (ARS), and above all, that reduce people’s out-of-pocket expenses, that is, the differences paid by affiliates, in search of a definitive solution to this crisis in which every second counts, because people’s lives are at stake”, he says the notice.
Regarding the National Professional Fees Committee, he explains that it is made up of seven members: “two government representatives, a representative of Senasa, a representative of the private ARS, two health professionals in the corresponding specialized areas and a representative of the affiliates. , this last representation falls on the didaan entity that is willing to assume its responsibility in this mechanism as soon as it is convened”.
frank dialogue
“We propose a frank dialogue in which the parties in conflict arrive at the equitable and definitive solution of their differences so that the members of the Dominican Social Security System (SDSS) receive health services in an environment of peace and security”says the statement signed by Serrata.
This Tuesday, the Medical Association and the medical societies declared war on the Health Risk Administrators (ARS) and announced their disaffiliation from the Universal ARS, which has 325,000 members, around 7% of the country’s insured.
Prior to this decision, the cmd He withdrew from the dialogue he was holding with the ARS, under the mediation of Sisalril, so that his fees could be increased.
What ARS Universal Said
ARS Universal Vice President of Communications, Chisty Luciano, admitted that they have received some calls to the call center, but a very minimal number.
“We have been contacting our clients and intermediaries to give them peace of mind and we have an open channel”, he stressed.
On the possibility of appealing the decision of the cmd before a court, he said that they have not contemplated “any action”.
