Sunday , May 22 2022

Medimás leaves three departments as mandated by the Superintendent of Health – Health


The Superintendent of Health confirmed this Wednesday the partial revocation of authorization of the EPS Medimás in the departments of Chocó, Sucre and Cesar.

This decision, in practice, means that EPS will no longer be able to operate in these regions, and the nearly 60,000 members there had to be transferred to other insurance companies.

This recall process began last January, when the Superintendent of Health found that Medimás did not guarantee the delivery of health services to the affiliate population. met the conditions of quality, opportunity, accessibility, security, relevance and continuity, pursuant to resolution 3818 of 2019.

According to the Superintendent's report, today Medimás has 9,313 members in Chocó, 28,417 in Sucre and 31,282 in Cesar. In these departments, Medimás recorded the lowest performance compared to the other EPSs.

"The measure adopted aims to mitigate any risk to users affiliated with Medimás in these departments. We will be guarantors in this transition process. It should be made clear that these affiliates will not last a single day without insurance and the receiving EPS will be responsible for further guaranteeing first day care, services and medications without interruption. ", said Fabio Aristizábal Ángel.

In this regard, the Superintendent also informed that the transfer process of the 59,000 members It starts this Wednesday at EPS Famisanar, Sanitas, Nova EPS and Salud Total, that from September 1, the insurance will be responsible.

  1. Users in Cesar living in Valledupar, Aguachica, Agustín
    Codazzi and Bosconio will be transferred to Famisanar, Sánitas, Nova EPS and Total Health.

  2. Users in Chocó, who live in Quibdó, Bagadó and El Carmen de Atrato, will be transferred to Nueva EPS, Sánitas.

  3. Users in Sucre, who live in Sincelejo, Corozal, Coveñas, La Unión, Majagual, Sheep, Sam Poste, San Marcos, San Onofre, San Pedro, Sincé, Sucre, Tolú and Tolú Viejo, will be transferred to Sánitas, Nova EPS and Total Health.

Supersalud has its service channels throughout the national territory, so that users can consult with their regional offices, the toll-free service line 01 8000 513 700, the website and the social media accounts. @Supersalud on Twitter and / Supersalud on Facebook, for personalized attention 24 hours a day, 7 days a week.

The findings

This decision is based on the results of the inspection, surveillance and monitoring actions performed by the Superintendent of Health since October 2017, when special surveillance on this EPS was adopted.

"However, despite the follow-up and the actions taken, Supersalud has concluded that Medimás has failed to comply with any aspects that compromise the efficiency of service provision, member security and resource allocation in the sector.", The entity said in a statement.

Specifically, the EPS does not have in these regions the conditions for providing the services, for repeated and unjustified breach of the technical, administrative or scientific conditions that endanger members; as well as the terms of financial authorization and the timely turn to health care providers, as detailed in the resolution.

A report from the Superintendent's user protection delegate notes that this has been found Medimás also failed to meet the average time indicators for initiating treatment for breast cancer, at the time of delivery for the delivery of benefit plan drugs, in treatment formulas delivered in full and on time. And less in order to reduce the number of complaints in the two regimes.


Source link