The decision informed last week by the German Clinic to the affiliates of the Consalud and Nueva Masvida isapres, putting an end to the Preferred Care Provider Agreement for hospitalizations in that institution -replacing the institutional direct payment modality for reimbursement- has been followed by other providers.
This is the case of RedSalud – linked to the Chilean Chamber of Construction that controls clinics and medical centers – which applied a commercial policy along the same lines as Nueva Masvida. And although signs in this sense had already been made known by people who have exposed their situations on social networks, industry sources confirmed that RedSalud’s decision ultimately implies a step further, since it decided to end no only to the direct payment of hospitalization care, but also for outpatient services.
That is, medical consultations and other procedures that do not involve hospitalization. In this way, Nueva Masvida affiliates must pay for all benefits in RedSalud -without being able to use automatic bond issuance models such as those that operate through the fingerprint with the IMed system- and then must subsequently request reimbursement in that isapre It transpired that the measure has already begun to be informed to patients and will come into force soon. Although the foregoing only changes the payment method and not the conditions of health plan coverage, this is seen in the industry as a hardening of commercial relations that other providers are also analyzing, said sources consulted.
It should be remembered that Clínica Alemana explained the measure towards Nueva Masvida and Consalud due to the “breach of the contractual obligations of the agreement by both isapres and that” it is taking the necessary actions to maintain the continuity of patient care, given the context and the financial situation that the isapres themselves have reported”.