Sisalril disallows clinics to charge advance payments or deposit fees

The Superintendency of Health and Labor Risks (Sisalril) reminded health service providers that there is a resolution that prohibits the collection of advance payment or deposit from admitting a patient to a health center and asked those affected to formally file their complaints with the Directorate of Information and Defense of Affiliates (DIDA) and that agency.

The system’s regulatory body urged members to contact their insurer or contracted ARS immediately when they arrive at a health center, and a deposit is demanded to admit them in cases where they present their Family Health Insurance (SFS) membership cards or receive treatment that they consider is not humane.

“The Superintendence of Health and Labor Risks prohibits the collection of advance payment in Health Service Providers contracted by the affiliate’s ARS, provided that the procedure to be performed is part of the benefits of the Health Services Plan (PDSS),” said the Sisalril, in releasing its official position on the issue.

That prohibition, it said, is following what was established in its Sisalril Resolution No. 156-08.

“We urge the affiliated population to make their ARS aware of this non-compliance, so that according to the contracts they hold, they demand adherence to the agreements between parties, if the provider does not assume the change of conduct, we urge the affiliates to make their complaint known to the DIDA or the Sisalril to execute the regulatory mechanisms empowered by Law 87-01,” it said.

The institution’s position was stated yesterday in view of the constant complaints from patients and relatives that have arisen in recent days in the country linked to the demand for an economic deposit that sometimes exceeds 100,000 pesos when they go to a private health center and their relative needs to be admitted, which often happens during the night hours which makes it more challenging to comply with the requirement.

On the subject, the day before, the president of the Association of Private Clinics and Hospitals (ANDECLIP), Rafael Mena, had assured that the clinics do not violate the law by charging admission deposits and said that these health establishments are forced to cover themselves given the non-compliance with the Social Security Law and the non-revision of costs according to the inflation index.

He said that the responsibility of the clinics is to stabilize every patient that arrives at their emergency services, which is always done, but that at the time of admission, they must have a guarantee of financing because these centers do not receive a subsidy from the State; they do not receive the inflation adjustment for the services they provide to members and on occasions, although they have an insurance card, they do not have the coverage for the service provided.

In his opinion, the complaints and weaknesses that patients have and that the system suffers from are the results of the non-application of the law and the fact that in the National Social Security Council (CNSS), the actors who know and suffer the patients have no vote or veto power.

Resolution
Administrative Resolution 00156-2008 issued by the Superintendence of Health and Labor Risks (Sisalril) provides in its first article that “The Health Risk Administrators (ARS) are ordered to guarantee, as of this resolution, that in no case or circumstance the Health Service Providers (PSS) contracted by these, require Family Health Insurance (SFS) affiliates to make advance payments or deposits as a guarantee for the medical-surgical care services they require or deny the service for not making such deposit or advance payment.”