After the national government released the prices of coinsurance – the amount of money that is not covered by the patient’s health insurance and that must be paid for each health care service – within the basic health plans that offer prepaid and social works, the figure of the “compensating tariff”or wrongly called copayment, which the Medical providers charge patients with medical coverage. Some define it as an “immediate solution” that professionals found for do not abandon care by card.
Fifty scientific societies and other professional entities in the country endorsed this modality.It is not a coinsurance. It is not an additional. It is not a copayment. –they clarify, once again, in response to the query–. It is a non-refundable complementary voucher, a private agreement between the patient and the doctor.” On the patient side, The measure still generates confusion and complaints When, at the end of the consultation or when presenting for an imaging study, they are billed for an extra payment that had never been requested before.
To find out in which cases this mechanism is applied at the local level, we consulted Julio Pratesipediatric surgeon and president of the Puerto Madryn Medical Association, Why are extra amounts charged for consultations or services?such as laboratory or imaging studies, if the patient pays coverage every month.
“We have the figure of the compensatory tariff, which is an additional fee that we charge when a health insurance company does not pay on time and in the correct manner. This occurs after not obtaining increases in values, trying to negotiate and contemplating a waiting period until the situation is regularized. There are situations where there are delays of more than 2 months from the date that they should have paid.“explained the medical professional in dialogue with Channel 12.
It is not a new practice, since for years there have been doctors in their offices who charge patients with coverage a fee to compensate for the payment of fees, even when it is not regulated by contract. Beyond that, in mid-2023, professionals from different parts of the country began to implement a non-refundable complementary bonus: its value is the difference between what a coverage pays for a consultation and what medical associations consider that It is the minimum ethical fee that that doctor should receive.
In this context, Pratesi explained that, in general, Local providers charge 30, 45 or 60 days after presenting the invoice. “Sometimes we end up receiving payment three months after having provided care, but there are health insurance companies that are even more delayed after that period. In some circumstances, the College says: ‘Since you – health insurance/prepaid insurance – are not going to compensate me for that, something else will be added.’”
The doctor stressed that the College informs all providers of the application of said additional amount and, at the time it is established, they send a communication that is displayed in the offices. It states that for a certain health insurance company an additional amount of X value is being charged for late payments.
Coinsurance
On the other hand, when asked why the patient must pay coinsurance to the health company, Pratesi pointed out that, many times, it works as a mechanism for “additional collection” by the entities. “That is, I pay my fee but the plan I am paying for is very low. There are cases in which you go with your prepaid card and you don’t have to pay anything additional, but there are companies that have standard plans.”
“However, the client is aware that they pay a low plan and if they have to perform certain medical practices they will be charged an additional fee; It is the way that social and prepaid works have to offset the value a little. Sometimes, in the negotiation of values, the social work tells me ‘I can’t give you an increase, but we are going to establish a coinsurance that the member will pay in the office or at the headquarters of the social work. Each social work has a different mechanism,” added the head of the Puerto Madryn Medical College.
