Medical Insurance plan problems : Universal and others

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The CMD will continue to disaffiliate ARS to force migration to Senasa Senén Caba said that the next ones would be the six ARS that make up Adimars The ARS that make up Adimars are ARS APS, ARS Asemap, ARS Futuro, ARS Renacer, ARS Metasalud and ARS GMA Claudia Fernandez Santo Domingo - Oct. 21, 2022 | 12:01 AM m. | 6 min read

  The president of the Medical Association, Senén Caba. (DIARIO LIBRE/KEVIN RIVAS) The president of the Dominican Medical College, Senén Caba, affirmed yesterday, Thursday, that the CMD's plan to fight against the ARS will include the disaffiliation of the six entities that make up the Dominican Association of Equal Medical & Health Risk Administrators. Health (Adimars). “Andeclip has just been integrated. They are also going to disaffiliate not only from the Universal ARS, they are going to disaffiliate from the small ARS, Adimars as they are called”, said the doctor when making an appearance at the seminar “Past, present and future of Family Health Insurance” , organized by the Alliance for the Right to Health (Adesa). The ARS that make up Adimars are ARS APS, ARS Asemap, ARS Futuro, ARS Renacer, ARS Metasalud and ARS GMA. Caba stressed that before the ARS, “we understood each other well, members and doctors. There was a medical equal and you paid for a consultation, but at this moment, how do you attend to a patient for 350 pesos? People say that one is a usurer, an abuser, but how do I maintain a practice if it is not like that, ”questioned the president of the doctors. He emphasized that the ARS “are not doctors, nor are they patients. What do they do in this concert between doctors and patients? They came to mediate, but not only to mediate. Of the resources that are invested in health, which until now are close to 700 billion pesos, they have won everything”. Of the 45 billion pesos that are invested in medicines, Caba maintained that the ARS barely contributes 5 billion, 'people buy the rest out of their own pockets.' “Providers invest a lot of money in offices, secretary, security, fuel and the payment they receive per patient is the same since 2015 (RD$360.00); while the ARS have risen with 188% of the increase to the capita”, he added. Senén called on members to 'empower themselves, take to the streets with us for another model of Social Security, more based on your rights, without abuses for us providers.' Non-negotiable points Caba highlighted two main points where the doctors are not willing to give in at the dialogue table: the basic health plan and the assignment of codes to doctors. “We believe that the time has come for the ARS to cover a basic plan for illnesses. The basic plan began to mutilate since the Family Health Insurance was created in 2007, leaving people with fewer and fewer illnesses and procedures within the coverage”, assured the doctor. Regarding the assignment of codes, he said that 'we are not going to negotiate in any way, let the Government and the ARS know, who certifies a doctor to practice.' And the affiliates? The coordinator of the Social Security commission of the Dominican Medical Association, Fulgencio Severino, understands that the practical solution for members is to migrate to another ARS. “What the member has to do is transfer to another ARS. The National Council of Social Security (CNSS) that quickly approves that they go to an ARS until the conflict with Universal is resolved and Universal pays the other ARS”, he stated. “We are going to continue until everyone reaches the National Health Insurance (Senasa)”, he added.

As I understand this it is  coverage of the  LEGAL MANDATORY insurance set up by the government.  Very little impact on the  private insurance business at this point. I am confirming all of this!

Interesting, as I just heard from several long time resident friends, that all doctor offices are now declining to accept any Universal coverage plans.  Apparently Humana is still ok. Fine time to be evaluating options.

Oh wow, interesting!

The doctor / Universal  actions are about payment amounts and timing!   Universal needs to step up and amend their payment terms.  That, of course, can lead to higher premiums.

One critical piece of advice - make sure your plan allows for  repayment of expenses when you go outside their associated members!

@ynotbdiving very interesting comment, last week I took my daughter to IMG to see a doctor at the counter handed over my Universal card and they said they can't accept it as there is 'technical problem'  but stressed it wasn't just our card and we should claim directly from Universal, which I wasn't going to do. 

Yup that is what is happening in many locations