By The Star Staff
Health Secretary Carlos Mellado López on Tuesday issued a warning to First Medical Health Plan for violating the provisions of the Vital Plan contract.
The warning, which was also sent by the island Health Insurance Administration (ASES by its initials in Spanish), came in response to multiple allegations from service providers contracted by First Medical regarding the lack of payment for the provision of health services under Medicaid and the Vital Plan, which may affect access to health services for patients beneficiaries.
ASES had issued two letters of intent to fine First Medical in recent months after it did not comply with the corrective action plan submitted regarding payment to suppliers. The letters of intent were appealed by the insurer and are under administrative review before the agency.
“Our priority in the past three and a half years has been to improve payments to providers and provide better health services to citizens,” Mellado said. “We have been monitoring all health insurers for years to ensure that they comply with this public policy. In this case, we are taking strong actions to ensure that the Plan Vital contract and payment to suppliers are complied with.”
ASES has addressed complaints from the sectors that requested a forum, the Health chief noted.
“Likewise, it maintained open communication with First Medical in the process of achieving an adequate conciliation according to the responsibilities agreed to under the contract with ASES for the Vital Plan,” Mellado added. “However, we have not seen proactive or consistent actions.”
The warning emphasizes that ASES has had to intervene under Articles 19 and 20 of the Plan Vital contract due to the same allegations of non-payment to suppliers, so it will be taking action in this regard, which could ultimately lead to the cancellation of the contract.
“We are granting the insurer until August 1, 2024 to comply with the protection of the beneficiaries of the Vital Plan who use their providers for continuity of medical care,” ASES said in a statement. “Our goal is to ensure payments are made to health care providers so that beneficiaries can continue receiving the services to which they are entitled. If we do not see action, we will take whatever measures are necessary.”
The lack of payment to the service providers contracted by First Medical could also cause changes in insurers without cause by the beneficiaries of the Vital Plan as a way to guarantee access to the services and treatments they receive. Currently, First Medical provides services to some 291,000 Vital Plan beneficiaries. In addition to First Medical, the Vital Plan’s contracted plans include MMM, Plan de Salud Menonita and Triple S.