Doctors and clinics "will not accept" Humano insurance

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Chirimoya

Guest
If you're insured with Humano you may encounter problems. As usual, the article does not give any background about the dispute that resulted in two medical associations and the private clinics' association announcing they would not be accepting ARS Humano insurance, except for emergency situations, until further notice.

Check with your broker first, but I would hope that the clinic will give out receipts that can then be reimbursed by the insurer, like the doctors who routinely do not accept insurance.

https://listindiario.com/la-republi...seguradora-garantiza-servicio-a-sus-afiliados

https://www.espaciodeprensa.com/201...clinicas-suspenden-servicios-a-la-ars-humano/
 
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dv8

Guest
probably payment issues. some insurances take a long time to pay the bills and sometimes apply a discount.
 
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SKY

Guest
Today's DR1 News

Humano medical insurance suspended
The Dominican Medical Guild (CMD) together with the Board of the Specialized Medical Societies (Conasomep) and the National Association of Private Clinics (Andeclip) have announced the suspension of consultations and elective procedures for those patients holding ARS Humano medical insurance. There has been no announcement as to the length of time this suspension will last. The boycott is to start on Wednesday, 1 May 2019 when only emergencies and those patients in intensive care will be able to claim under their insurance with Humano.

The announcement comes as the organizations say they will step up actions in favor of increases in the fees and tariffs for their services. The intention is to extend the boycott to the other around 20 medical insurance providers authorized in the Dominican Republic. CMD president Wilson Roa said that the physicians cannot take it anymore and that according to the CMD regulations they had no choice but to take corrective and disciplinary measures. Roa says that the ARS Humano has not complied with agreements that had been signed in 2017, as reported by Diario Libre.

ARS Humano is the country’s leading private medical insurance plan with around 33% of the medical insurance plan market, serving around 2.5 million people.
The other leading medical plans are Palic Salud, Universal and the governmental Senasa that covers those on the subsidized regime.

The Colegio Médico Dominicano, Consejo de Sociedades Médicas Especilizadas and the Asociación de Clínicas y Hospitales Privados say medical services fees have stagnated despite Social Security Law 87-01 ordering revisions every three years. Adjustments have mostly affected the difference patients pay that can range from RD$250 to RD$1,100 depending on the clinic and the plan. In most cases, the difference is more than they are paid by the medical plan companies.

The medical organizations also demand that patients maintain free choice in medical services, and that primary care begin with the subsidized regime. The insurance scheme has proven to be highly profitable for the medical plan operators. ARS Humano recently inaugurated a large office building on Av.. John F. Kennedy.

https://www.diariolibre.com/actualid...les-LB12648065
http://www.sisalril.gov.do/pdf/leyes/ley_no_87-01.pdf
https://listindiario.com/la-republic...ntre-afiliados
https://humano.com.do/Paginas/default.aspx
https://eldia.com.do/pacientes-a-merced-de-mercaderes/
https://eldia.com.do/lucha-por-fondo...-sin-servicio/
https://www.diariolibre.com/actualid...dos-LA12650193
https://www.diariolibre.com/opinion/...rio-CA12651829
 
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windeguy

Guest
Reading about this on other sources and it looks like the Dominican doctors are going to go after all insurance providers to be able to be paid more. Humano, being a big fish, was targeted first.

Recently my wife underwent a minor surgery at a local clinic. The first question the doctor asked in the operating room was how much he was going to make for the procedure.
 
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josh2203

Guest
Recently my wife underwent a minor surgery at a local clinic. The first question the doctor asked in the operating room was how much he was going to make for the procedure.
Funny you should say that: Brought to my mind an observation I made a long time ago:

My father-in-law had a to have a minor surgery in Santiago - his doctors convertible new Mercedes was parked right outside the entrance of the private clinic... No complaints of the work done at all, but my FIL got suddenly a lot poorer, despite being covered by his insurer...

Meanwhile, our son's German surgeon (in Germany, when we lived there) arrived to a clinic to remove his tonsils, which is a lot more complicated procedure than what they did to my FIL in Santiago... The surgeon arrived and left with his bicycle, wearing an appropriate helmet of course...
 
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Samana_Sanchez

Guest
Funny you should say that: Brought to my mind an observation I made a long time ago:

My father-in-law had a to have a minor surgery in Santiago - his doctors convertible new Mercedes was parked right outside the entrance of the private clinic... No complaints of the work done at all, but my FIL got suddenly a lot poorer, despite being covered by his insurer...

Meanwhile, our son's German surgeon (in Germany, when we lived there) arrived to a clinic to remove his tonsils, which is a lot more complicated procedure than what they did to my FIL in Santiago... The surgeon arrived and left with his bicycle, wearing an appropriate helmet of course...
LOL liked the helmet part
 
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cobraboy

Guest
Funny you should say that: Brought to my mind an observation I made a long time ago:

My father-in-law had a to have a minor surgery in Santiago - his doctors convertible new Mercedes was parked right outside the entrance of the private clinic... No complaints of the work done at all, but my FIL got suddenly a lot poorer, despite being covered by his insurer...

Meanwhile, our son's German surgeon (in Germany, when we lived there) arrived to a clinic to remove his tonsils, which is a lot more complicated procedure than what they did to my FIL in Santiago... The surgeon arrived and left with his bicycle, wearing an appropriate helmet of course...
I may be alone, but I WANT my doc to be so successful and good at what he does he has a fleet of Mercedes.

Keep in mind a good number of the better docs in the DR were born into wealth.
 
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josh2203

Guest
I may be alone, but I WANT my doc to be so successful and good at what he does he has a fleet of Mercedes.

Keep in mind a good number of the better docs in the DR were born into wealth.
Yes - you are right on these two things... I suppose my remark only had to do with the fact that here's who is successful, wants also others to know about... I agree, I would much rather be treated by a professional to whom I have to pay a lot as opposed to going to a public hospital (here)...
 
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william webster

Guest
Pay the doctor.... or pay the funeral home

your choice
 
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SKY

Guest
Government expects boycott against ARS Humano to be called off
Minister of Labor Winston Santos and Superintendent of Health and Labor Risks (Sisalril) Pedro Castellanos announced they reached an agreement with the representatives of the Dominican Association of Health Risk Administrators (ADARS) that groups the medical plan providers to avert the boycott to the largest medical plan provider, ARS Humano. The agreement is scheduled to be signed by the parties in conflict on the same day the boycott would start, Wednesday, 1 May 2019.

The Dominican Medical Guild (CMD), the National Board of Specialized Medical Societies (Conasomep) and the National Association of Clinics and Hospitals (Andeclip) have announced a national strike against the medical insurer ARS Humano.

In a joint press conference, CMD president Wilson Roa had explained that on the list of demands is an increase in medical fees for consultations and tariffs for procedures in the health centers and free choice for the patients. He has said that they are open to dialogue with the ARS if they comply with these and other points agreed upon in 2017. Roa said they are working with the Trajano Potentini law firm to take legal actions in this direction.

Meanwhile, if the boycott is upheld, ARS Humano public relations representative, Cinthia Modesto told El Dia that patients would be referred to other specialists that are not members of the CMD. She said that users that incur in medical expenses can bill the medical plan for the difference. An estimated 1.3 million affiliates are expected to be affected by the boycott.

The Dominican Association of Health Risk Administrators (ADARS), that groups the medical plan companies (ARS) told El Dia that changes in the services catalogs are decided by the National Council of Social Security (CNSS).

ARS Humano lamented that the boycott affects their brand. The CMD has said while the boycott has become with ARS Humano, the largest medical insurance plan, it will continue with the other providers.

https://www.diariolibre.com/actualid...ars-AD12660770
https://listindiario.com/la-republic...s-a-ars-humano
https://eldia.com.do/los-afiliados-e...o-con-las-ars/
 
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windeguy

Guest
I wonder what is meant by "free choice for patients" in the alleged agreement to be put into effect today?
 
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SKY

Guest
Bad News Boycott Back On DR1 News Today

Boycott against Ars Humano is on
The Dominican Medical Guild (CMD), National Council of Specialized Medical Societies (Conasomep) and the National Association of Clinics and Hospitals (Andeclip) are not accepting ARS Humano medical plans as of Wednesday, 1 May 2019. This affects around 1.5 million participants. ARS Humano is the largest medical plan insurance company in the Dominican Republic.

The boycott of the service went into effect despite the announcement by Labor Minister Winston Santos and Superintendence of Health and Labor Risks (Sisaslril) head Pedro Luis Castellanos that ARS Humano had agreed to comply with the 31 May 2017 agreements signed with the medical representatives. The medical organizations are demanding the agreements of 2017 be met, including increases in fees and tariffs, start of primary care plan with the subsidized regime, and the free election of service by the patients, among other points.

The president of the CMD, Wilson Roa, told the press that after a meeting with Labor Minister Winston Santos and representatives of the ADARS, an agreement was not reached, each only presented proposals. Roa complained that the ARS continues to set aside only RD$262 per consultation for many physicians.

Former CMD president Waldo Suero said the government will not amend the Social Security Law so as to not confront big business. He said this is despite the fact that the Executive Branch sent to Congress an amendment to Law 87-01 on Social Security. He said if Medina really wanted to change the law he would meet with the Political Committee to agree on the changes and order these changes be drafted by majority PLD legislators, just as he did when he wanted to be reelected. “He is not going to do it because it is not politically convenient,” he said. He said the Social Security Law 87-01 was drafted to benefit big business and bankers and that the social security system in the Dominican Republic has collapsed.

Meanwhile, the general manager of the National Social Security Council (CNSS), Rafael Perez Modesto, disputed a recent public statement by the Dominican Association of Health Risk Administrators (ADARS), the association that groups medical plan administrators. ADARS had said that the claims made by the medics and clinics are decided by CNSS. CNSS says that they have no contractual or financial relationship with the providers. “The role of the CNSS is to draft the policies and norms of the Dominican Social Security System,” he stated. He explained that the way the system works is that the physicians and other health service providers sign contracts with the Health Risk Administrators (ARS), who in turn are regulated and supervised by Sisalril. Perez Modesto said that the Sisalril is the competent government organization to resolve the impasse between the ARS the medical groups.

ARS Humano said plan members that are affected can call their call center 24/7 at 809 476-3535 in Santo Domingo and 1 809 200-4903 outside Greater Santo Domingo.

https://www.elcaribe.com.do/2019/05/...ro-de-trabajo/
https://www.youtube.com/watch?v=jz8X_426bnI - Huchi Lora
https://noticiassin.com/afiliados-a-...los-servicios/
http://z101digital.com/waldo-suero-d...r-empresarios/
https://www.elcaribe.com.do/2019/05/...o-hay-acuerdo/
 
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RDKNIGHT

Guest
Okay while we are on the topic of health Insurance which one would the folks here say is the best health care provide ??????
 
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JDJones

Guest
Okay while we are on the topic of health Insurance which one would the folks here say is the best health care provide ??????
Most folks seem to think Humana is the best (most clinics and health care folks say they are the easiest to deal with. That may change) followed by Palic, then Universal.

YMMV