2023-09-25 17:01:00
Last week, through a statement, more than 30 medical associations announced a new “minimum ethical medical fee” for professional consultation of 6,000 pesos (Europa Press)
In the midst of a context that prepaid medicine companies define as “total definancing” and a price freeze in installments that is in force until the end of October, a new controversy arose in the private health care sector. And it has to do with co-payments.
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Last week, through a statement, more than 30 medical associations announced a new “minimum ethical medical fee” for professional consultation of 6,000 pesos. “If what we receive from the system (social works, prepayments, sanatoriums, among others) is less than this amount, the difference will be covered by the patient as a non-refundable complementary bonus,” they noted.
In the prepaid medicine sector they say two things: that in general there is no charge, or at least very few doctors do, and above all that it is not appropriate to charge them.
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There is no need to pay, said the companies in the sector that Infobae spoke with. And if you pay, you have to notify the prepaid company by any means, even digital. That triggers the reimbursement system, discounts to the doctors who charged it, and possible sanctions.
“If an extra/copayment (which does not correspond to the Plan) is charged by a card provider, the member may request a refund” (Galeno)
“When a member tells us that they asked for a co-payment, we inform them that they should not pay it, because it does not correspond. If they still paid it and tell us, we initiate a process with the provider for improper collection. If they do not communicate it, we have no way of knowing if they are charged or not,” they explained in one of the largest companies in the sector.
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Regarding refunds if the payment is made, in general the prepaid companies make the refund upon presentation of the invoice, at least until now. But not in all cases: for example, Swiss Medical and Galen do; Osde has the particularity of being a kind of double company, prepaid and social work.
From Galeno, for their part, they detailed that “if an extra/copayment (which does not correspond to the Plan) is charged by a card provider, the member can request a refund. It is a requirement for its management that the partner present the invoice or tax receipt.”
From the sector they say that in the last 4 years costs and supplies increased by 600% and the prices of prepaid plans by 400% (Gettyimages)
Another of the large companies in the market stated that co-payments are not contemplated in the contracts between the financier, the prepaid companies, and the doctors. “They are not considered drunk, they are prohibited. Furthermore, the relationship and contracts are direct with the doctors, not with associations or the like. We understand the situation of doctors, but the issue is that the sector was already underfunded before, with high inflation and an increase in exorbitant supplies, both in medicines and supplies of all kinds. In the last 4 years all of this increased by 600% and the prices of the plans by 400%, they said.
The large companies in the sector assure that the charge is not massive, not at all, but that some cases appeared in the interior, for example in Mendoza.
As mentioned, last Thursday, Health Day, more than 30 medical associations announced the charging of fees for consultations. In other words, the difference between the minimum fee that they established at $6,000 and the amount they receive from the prepaid and social works system will be requested from the patient.
“The medical consultation is a fundamental act in which we attend to the needs of our patients, diagnose diseases and work on their recovery. It is also the act through which we receive a professional fee that allows us to live with dignity,” the text detailed.
You must notify the prepaid company by any means, even digital. That triggers the reimbursement system, discounts to the doctors who charged it, and possible sanctions.
“Traditionally this service was valued by health funders, but we have never had the ability to set its value ourselves. We professionals were never able to determine how much we should receive for this work and when we should receive it,” the associations expressed.
“In recent years, the value of medical consultations in our country has experienced a drastic drop, ranking as one of the lowest in the region. In recent months, this situation has worsened, adding to the delay in payment of fees between two and six months after providing our services. Unsustainable for health professionals today with the existing high inflation level,” they added.
The “minimum ethical medical fee” of 6,000 pesos will be adjustable bimonthly for inflation.
The text was signed by the associations of Orthopedics, Traumatology, Surgery, Head and Neck Surgery; Controversies in Obstetrics and Gynecology, Gynecological Oncology, Neurosurgery, Clinical Oncology, among others. Also the Argentine College of Cardiology; the Argentine Federation of Gynecology and Obstetrics Societies; the Argentine Federation of Otorhinolaryngology Societies; the National Federation of Neurosurgery; the Society of Gynecology and Obstetrics of Buenos Aires; the Argentine Society of Plastic, Aesthetic and Reconstructive Surgery among many others.
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