SISALRIL protects affiliates against conflicts between ARS and health providers
The Superintendence of Health and Occupational Risks (SISALRIL) has issued a clear directive for Health Risk Administrators (ARS) and Health Service Providers (PSS): contractual conflicts, rate differences, or payment issues cannot, under any circumstances, be transferred to the members of the Family Health Insurance (SFS).
The regulatory entity emphasized that any commercial disagreement must be managed exclusively through the established communication channels between the parties. In the event that a consensus is not reached, the issues must be escalated to SISALRIL itself, avoiding the end user being used as a bargaining chip or affected in their fundamental right to medical care.
Prohibition of improper charges and service restrictions
Through Circular 002957, the institution has been emphatic in prohibiting practices that violate access to healthcare, such as:
- Unjustified additional charges to affiliates.
- Conditioning or limiting medical care covered by the plan.
- Withholding of necessary documents for patients.
- Unjustified suspension of health services.
The differences between the system’s actors must not become obstacles for users. Guaranteeing timely access is a responsibility that ARS and providers must fulfill under the framework of Law 87-01.
Alofoke Deportes
Payment transparency and new provisions
As part of the measures to strengthen transparency, the regulations require health centers to provide detailed receipts for payments made for services included in the Basic Health Plan. Likewise, providers are urged to diversify their payment methods, facilitating the use of bank cards, transfers, and electronic means so that affiliates have clarity regarding the amounts of copayments and moderating fees.
SISALRIL reiterated the validity of Circular 000687, focused on the eradication of improper charges in both the Family Health Insurance and the Occupational Risk Insurance. The entity will maintain constant supervision over the network of providers, requiring ARSs to assume their contractual responsibility to sanction any irregularity that affects citizens.
