In the face of growing and ever more serious concerns about public safety, the newspapers are publishing stories about just how the insurance companies are denying coverage for gunshot wounds. The El Día newspaper cited the case of Francisco Perroa Pérez, 19, who was assaulted in Sabana Perdida by criminals who shot him when he tried to escape the assault, and then stole his cell phone. The young man was hospitalized in the Ney Areas Lora Trauma Hospital.
After a week of hospital care, Berroa discovered that his insurer, the government’s SeNaSa would not cover any medical fees derived from gunshot injuries. Berroa was forced to borrow a lot of money to pay his hospital bills. Even the hospital administration is at odds with the situation since it frequently finds itself fighting with SeNaSa over patient care issues.
The SeNaSa spokesman, Santiago Benjamin, explained that the lack of coverage is because a gunshot wound is not included in the catalogue of illnesses covered by the Basic Family Health Insurance Plan. He added: “It does not matter what the cause is, coverage depends on the procedures needed by the patient have to be in the catalogue of services approved….” He said this is the same for all health plans in the DR.
However, the director for trauma care at the Ney Arias Lora Hospital told the reporters that this denial of service only seems to come into play when the victim has a gunshot wound, since victims of traffic accidents are routinely covered without incident. At the same time, the Superintendent of Labor Health and Risks (Silsaril) has stated that the coverage of the Basic Plan does not contemplate any exceptions for cases of gunshot wounds.
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El Dia
21 October 2019