2,256 people They filed their complaint with the authorities when they discovered that their health insurance had been changed without their consent.
This data from the General Directorate of Information and Defense of Affiliates (DIDA) reveals that the practice of claiming irregularly insured status continues despite the efforts of the Superintendence of Health and Occupational Risks (Sisalril) for eradicating it.
Eleven Health Risk Managers (ARS) have been fined by Sisalril for amounts totaling 235.5 million pesos in the last six years for engaging in this practice, especially the one named APSdirected by the businessman Alejandro Asmar.
All the sanctions of the year 2025 fell on APS: 185.8 million pesos for 1,579 irregular transfers. One of the injured is Gabriel Araújoa young man from 19 yearswho recently discovered that he is no longer affiliated with the ARS First, but APSwithout knowing how or when the change occurred.
His case is aggravated because ARS that has been imposed on him does not give him a card to be able to be treated by a hypertension and strong headaches who began to suffer. His mother says that the young man is being treated for headacheswill have to undergo surgery and has had to go through an ordeal seeking medical attention without an insurance card.
“They don’t even give us an office address to look for him. My son is treated in a hospital and it takes up to two hours waiting for an approval. We have had to pay for a consultation because the approval takes a long time. Then they don’t take the call,” said his mother. Pilar Araújo.
Free Diary was able to see how difficult it is to communicate with someone in APS. After waiting 10 and 20 minutes on the phone, a voice says goodbye in English and closes the call. This newspaper also contacted a representative of the company, who agreed to manage a institutional response to the questions, but at the close of this edition it had not been obtained.
“I would like you to tell me where I look for my card. I need it with urgency“Please!” he exclaimed. Gabriel.
7,159 transfers
The financial statements of APS reveal that their membership portfolio had been falling in 2020 and 2021, but registered a sudden increase in 2022, going from 37,289 to 47,847.
In it 2023rose to 49,848 insured and in 2024 it continued to rise.
Sisalril fined her last September only for 39 casesbut in his research he states that APS performed in the 2024 some 7,159 transfers under the modality of family unification91.84% of the general total of transfers made by all the ARS of the system.
The few people who complained have testified that APS has united them to family nucleus of one of its members as husband or wife and then register a divorce and that the person ends up in your customer bank.
The growth of its affiliate portfolio has coincided with an increase in its profits, which went from 64.7 million of pesos in the 2023 to 225.1 million in it 2024according to its financial statement available on the Sisalril website.
weak justice
The director of the DIDA, Elias Baezconsiders that justice has been weak and the Public Ministry has given little follow-up to several cases that the Social Security Treasury has brought to them.
“The DIDA has received and processed 2,256 claims last year, for irregular affiliationstransfer between ARS and by records of family nuclei with unknown people,” the entity’s statistics department reported yesterday.
The head of the DIDA, Elías Báez, denounced that the majority of the ARS are not acquiring high-cost medications through the Directorate of Access to High-Cost Medications (Damac), as established by Resolution 553 of the National Social Security Council (CNSS). The DIDA issued a press release explaining that this practice violates the resolution, “which prevents members from having access to medications at a lower cost.” Báez explained that Damac makes wholesale purchases and maintains international agreements that allow drugs to be offered up to 80% cheaper than in the regular market. The director of the DIDA urged the ARS to comply with ruling 111-19 of the Constitutional Court, which provides that insurers must supply the necessary medications as long as there are funds available in the Family Health Insurance (SFS), even when the drugs are not included in the catalog of the Health Services Plan (PDSS). Likewise, he recalled that “the ARS must assume the coverage of the patient before transferring him to the High Cost Program.”
