Medical Association calls for physicians not to accept Mapfre coverage

[Dolores]

Check your coverage if you are affiliated to Mapfre Salud ARS medical insurance plan. As of Monday, 14 November 2022, you may no longer be covered.

The Dominican Medical Association (CMD) is calling for physicians not to accept Mapfre (BHD Bank) insurance coverage as of Monday. Previously, the CMD had banned doctors from taking Universal (Banco Popular) medical insurance.

Dr. Senen Caba has said the suspension will be indefinite.

The CMD has complained against the insurance companies selecting which doctors can be in their plans. It also complains about the low pay physicians receive at a time when insurance companies’ profits have been on the rise. The medical insurance companies enjoy high yields.

The CMD says physicians will continue to attend to patients but they need to be paid directly by the patients. Diario Libre reports that in many cases, the insurance company will...

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[bob saunders]

Sounds like a court case coming soon.

 

[JD Jones]

The ARS's and the AFP's are starting to come under a lot of scrutiny because of the massive amount of money they are pulling in and the minimal payments they make.
I was talking to my doctor the other day and he doesn't hold back when talking about the ARS's. He hates them.

 

[chico bill]

I have Monumental and it is close to useless too.
I was told I needed pre-approval for treatment of a broken finger and went to their kiosk in Bournigal to get the OK at 11AM the morning I went to POP and was told they would not have a response until 2:30 to 3PM, which after the time of the doctor's office hours that day.
Wound up paying 100% out of pocket.
No money upfront or no pre-approval - no medical treatment.
It's the old "No ticky, no washy" routine.

 

[RDKNIGHT]

I have humano . pretty good so far ....

 

[JD Jones]

Humano seems to be the best you can get these days.

 

[bob saunders]

I have Monumental and it is close to useless too.
I was told I needed pre-approval for treatment of a broken finger and went to their kiosk in Bournigal to get the OK at 11AM the morning I went to POP and was told they would not have a response until 2:30 to 3PM, which after the time of the doctor's office hours that day.
Wound up paying 100% out of pocket.
No money upfront or no pre-approval - no medical treatment.
It's the old "No ticky, no washy" routine.

I have MAFRE and both my wife and I have used it at Union Medica with almost immediate approval.

 

[SKY]

I have had Monumental for many years here and never have had a problem using them...........

 

[XTraveller]

I have Monumental and it is close to useless too.
I was told I needed pre-approval for treatment of a broken finger and went to their kiosk in Bournigal to get the OK at 11AM the morning I went to POP and was told they would not have a response until 2:30 to 3PM, which after the time of the doctor's office hours that day.
Wound up paying 100% out of pocket.
No money upfront or no pre-approval - no medical treatment.
It's the old "No ticky, no washy" routine.

Did you make claim afterwards?

 

[chico bill]

Did you make claim afterwards?

No. For 6500 pesos I am not going to fight for them to say no

 

[XTraveller]

No. For 6500 pesos I am not going to fight for them to say no

I can not talk about Monumental, but with Humano you can make a claim online, upload documents and they deposit what ever they pay in your bank. Very easy.

 

[chico bill]

I can not talk about Monumental, but with Humano you can make a claim online, upload documents and they deposit what ever they pay in your bank. Very easy.

Well that is a good thing. Perhaps Monumental has that as well.

However my finger was bent at 70 degrees to its original position and I was shuffling between xrays and the doctor after having already waited until his 1 PM start time. So, in order to not to miss his fairly short 3-1/2 hour work window,, and in order to get a cast put on - I just abandoned the faulty insurance
pre-approval process to return to his office after x-rays. .
.
If fact I wasn't even provided a receipt from the doctor..His assistant had already left by the time he finished with the cast. I was the last patient to be seen. Sounds like a circus I know.

 

[JD Jones]

Did you consider visiting the emergency room instead of going to your doctors office?

 

[La Profe_1]

Did you consider visiting the emergency room instead of going to your doctors office?

Wouldn't that give Bournigal the opportunity to tack on an ER charge? When I was scheduled to have my wrist re-set there I was told to go to the ER at 6 AM where I had an IV inserted and admitting paperwork done. My insurance was billed for the ER in addition to the surgery, hospital stay, anesthesia, etc. Since it was scheduled, that felt like bill padding.

 

[JD Jones]

Who cares as long as the insurance is paying for it?

I have used the emergency room at Clinica Abreu dozens of times and have never paid more than a few hundred pesos. Many of them were no charge.

 

[La Profe_1]

The point is, CB's insurance wasn't cooperating, he paid out of pocket. His bill could have been significantly higher.

 

[AlterEgo]

I have Monumental and it is close to useless too.
I was told I needed pre-approval for treatment of a broken finger and went to their kiosk in Bournigal to get the OK at 11AM the morning I went to POP and was told they would not have a response until 2:30 to 3PM, which after the time of the doctor's office hours that day.
Wound up paying 100% out of pocket.
No money upfront or no pre-approval - no medical treatment.
It's the old "No ticky, no washy" routine.

Terrible. Did you go to the ER at Bournigal?