The Administrators of Health Risks (ARS) – the local equivalent of an HMO – lack legal, regulatory and prescriptive basis for the denial of service to the affiliates of the Family Health Insurance through payroll deductions called “Regimen Contributivo,” according to the Superintendence of Health and Labor Risks (Sisalril). Sisalril says that if an affiliate of the Social Security System, a professional qualified to indicate a lab tests, established in the Catalog of Services of the PDSS, the ARS is obliged to provide service.
The press note published on 18 July 2018, in the El Nacional newspaper explains: “For the simple fact that the Doctor who prescribes a lab tests or study is not part of the network of persons contracted for service, service should not be denied to the affiliate.” The notice also says that if an ARS denies coverage, the affiliated client has the right to file a claim in the offices of the Director of Information and Defense of Affiliates (DIDA) and at Sisalril itself calling for an investigation of the particular case.
The president of the Dominican Medical Guild (CMD), Doctor Wilson Roa Familia, warned: “We are going to make the ARS understand that we will defend our rights as established by the law.” He went on to say that the ARS cannot affect the right of patients to choose who will carry out medical procedures or lab tests.”
Read more in Spanish:
El Nacional
19 July 2018
