Sociedad Urología suspende servicios a afiliados ARS Semma

Urology Society suspends services to ARS Semma members

Santo Domingo.– The Dominican Society of Urology announced the immediate suspension of its services to the AR Semma Health Risk Administrator and threatened to include other insurers in the coming days.

The entity made the decision due to the refusal of the ARS of the teachers of the public educational sector of the country not to negotiate the improvement of the rates.

In a released statement, the board of directors states that it has had several conversations with Dr. Daniela De León Ulloa, in charge of the Provider Management Division of the Semma Health Administrator, with the intention of initiating a dialogue that allows improving the rate of the ARS of teachers.

“It is very unfortunate that the teachers of our country, due to the promise that they will maintain their insurance after their pension, continue to have suboptimal medical attention, almost always being denied modern procedures, which relegates them to receiving obsolete treatments. Perhaps the best thing that can happen to teachers, in terms of health plans, is that ARS Semma be taken over by ARS Senasa,” the statement said.

He adds that despite the various communications held with this ARS, the proposals have not been heard because Dr. De León states that this institution does not make agreements with medical societies.

It refers that “law 87-01 paragraph 173 specifies that the minimum rates of professional fees will be established and reviewed annually by a national committee of professional fees.”

He points out that this committee is made up of seven members divided into two government representatives, one from the National Health Insurance, one from the private Health Risk Administrators (ARS), two health professionals in the corresponding specialized areas and a representative from the affiliates.

“The resolutions issued by this committee must be approved by the National Social Security Council (CNSS), which will establish the complementary rules for its constitution and operation,” he says.

In this sense, he announced that since its approval in 2001 and its entry into force in 2007, the ARS Semma has never revised its rate.

“The purchasing power of the medical class has decreased because the dollar rate in 2007, when the law and payment rate came into force, was 27.80 cents and today it is 55 pesos,” he says. .

And he adds that, however, “our equipment and work instruments are purchased in dollars, as well as the vehicle in which we transport ourselves, fuel, house that shelters us, to this is added the annual inflation rate reported by the Bank Central”.

Another point that keeps urologists irritated is that Resolution 175-09 of the Superintendence of Insurance and Occupational Risks (SISALRIL) establishes that if a procedure is covered by the Basic Health Plan, the equipment and expendable material that is used must be covered by the insurer.

In the event that the ARS refuses to cover such services, it would be incurring a violation of provision 175-09 and this is precisely what is seen every day, notes the statement from the Society of Urology.


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