Well, "long" is certainly a relative and subjective term, but there were 10 listed on page one and there were two pages. I'd say that's a pretty good number of clinics. Keep in mind that many "private clinics" are very small ones consisting of one doctor and not fit for anything but very basic "first aid" type of care. They are not a CMC type of private clinic.
- Thread starter NALs
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SENASA Coverage Expansion
Yes, and Corominas is a huge clinica. They have everything. I've been there. SENASA probably doesn't even work with most those really small clinicas I mentioned.
You can probably only use SENASA at Corominas with the paid plan. I just spoke with another Dominican friend who also said that the free SENASA is only good at public hospitals.
Right. The basic is free for Dominicans, The Larimar plan is for anyone and costs $$$
Government plans to increase coverage from one to two million pesos for SeNaSa affiliates in catastrophic illnesses-- July 21/22
www.presidencia.gob.do
President Luis Abinader, accompanied by Vice President Raquel Peña, ordered this Thursday to increase the coverage of catastrophic medical expenses from one to two million pesos for each of the events covered in the Basic Health Plan (PBS) .
This will benefit more than seven million affiliates, in their respective schemes in the Family Health Insurance (SFS), of the Dominican Social Security System.
President Luis Abinader said that health is and will always be the most important part of our lives, so "since we came to the Government we knew that this sector was a priority and that we had to act urgently, but knowing how to transform the model forever ”, emphasized the president during a ceremony held at the National Palace.
The head of state recalled that at the end of 2020 the Government managed to enroll two million more people in SeNaSa , and that now, the beneficiaries amount to seven million Dominicans throughout the country.
Gobierno dispone elevar cobertura de uno a dos millones de pesos para afiliados de SeNaSa en enfermedades catastróficas
Santo Domingo.- El Presidente Luis Abinader, acompañado de la vicepresidenta Raquel Peña, dispuso este jueves elevar las coberturas de los gastos médicos catastróficos de uno a dos millones de pesos por cada uno de los eventos cubiertos en el Plan Básico de Salud (PBS).
President Luis Abinader, accompanied by Vice President Raquel Peña, ordered this Thursday to increase the coverage of catastrophic medical expenses from one to two million pesos for each of the events covered in the Basic Health Plan (PBS) .
This will benefit more than seven million affiliates, in their respective schemes in the Family Health Insurance (SFS), of the Dominican Social Security System.
President Luis Abinader said that health is and will always be the most important part of our lives, so "since we came to the Government we knew that this sector was a priority and that we had to act urgently, but knowing how to transform the model forever ”, emphasized the president during a ceremony held at the National Palace.
The head of state recalled that at the end of 2020 the Government managed to enroll two million more people in SeNaSa , and that now, the beneficiaries amount to seven million Dominicans throughout the country.
I bought the Larimar plan in September. I've heard only good things about SeNaSa, about how it's the best, etc. So the plan is 80k a year for a family of four people. We haven't had to use it yet until today, my wife has the flu and wanted to see a doctor for consultation. The doctor is listed on their website as "in network" and supposedly it's supposed to be covered, but maybe there's copay or something. She went there and the doctors says no, SeNaSa is just basic insurance that doesn't cover anything and he won't accept it. So my wife gives him 2500 for the consultation (I now wish I would have gone along, I would have told him to take a flying leap at a rolling donut.) But anyway, has anybody used this insurance? I'm wondering if this is just a fluke on the first visit or if it's actually worthless. According to their marketing material it has reasonable coverage, relative to the price. She called them and they told her she needs to go their office and get a book of providers. Their website is not up to date but their printed book is? I could believe that in the 1990's.
Better check - Doctors no longer will accept Mapfre Salud ARS according to a report last week
Apparently, some places aren't accepting Universal now either. I just got a message from them that, if coverage is refused, get one of those official receipts with the RNC and submit it to them and they will reimburse you. I just saw a doc in CMC last week and didn't have any problem then.
It could be he is aware of the old SENASA.
Case in point, this was posted on October 24, 2022.
CMD recommends migrating to Senasa
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That's what I was told, too. When I asked for specifics why they did not want to accept Universal, I was told that the government sets prices doctors should receive for services. They pay that price. Doctors want to increase their pay, so instead of going after the government, they are going after insurance companies. Also, I was told that the refusal affects mostly consultations, not treatments.
I need total knee replacement surgery. I would hate to have to pay that myself and then be reimbursed. If that is what I need to do, I prefer to go back to the US and have my medicare take care of it.
Will go back to the doc this Friday and ask the question.
Here's the translation of part of the notification I received from Universal:
Please note that due to the *CURRENT STRIKE* maintained by doctors against ARS Universal and the other Health Risk Administrators, we inform you that as far as Universal is concerned, it only applies to *OUTPATIENT MEDICAL CONSULTATIONS AND PROCEDURES.* The other benefits of your plan, such as hospitalization, intensive care, laboratories and diagnostics remain active and you can use them according to your needs.
It sounds to me like you might have to pay out of pocket for any surgery. It probably depends on the doctor(?). Some might be happy on what Universal is paying.
Just like Canada, the government decides the fees that doctors get for consultations, operations...etc, and Canadian doctors are pretty well off. I suspect Dominican doctors are simply getting a little greedier.
I'm not sure that's true, but I could be mistaken. I've always been under the impression it's the insurance companies who determine how much they'll pay for each instance.
Well two of the posters above, Cavok and Lindsey report that's what they have been told.
Actually, that may be the case for Senasa since I think that's a government sponsored health insurance plan, but I have Universal ARS and it's private. I think in that case it's Universal that's deciding how to cover.
Every time I have gone to a specialist, they get a certain amount from the consultation from the insurance, and then they charge you anywhere from 500-1500 in cash, usually 1000 or 1500. I have only seen one doctor that doesn't take insurance and he charged 2000 for consultation. How much the doctor actually gets from the insurance company, I don't know.
I think that's what a lot of docs are doing. They take whatever the insurance gives them and then charge you more cash to get what they think is fair for a consultation.
SeNaSa replied to me and I can fill out a reimbursement form and they will do an investigation.
In my opinion the Doctor signed up as an affiliate and is listed in their referral network. If he doesn't want to accept the insurance he shouldn't be getting referrals. He is listed as a private provider at the hospital.