Viva La Casta, Carajo! Milei Sets Strong Restrictions on Reimbursements/Coverage for Prepagas; Creates 2 Tier System for Monotributistas.

Quilombo

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The latest assault on Argentines' health, err, I mean "the caste" is brought to us by Javier Milei and Gabriel Oriolo, the former OSDE executive and millionaire that now runs the Superintendency of Health Services:


According to Resolution 3934/24 in the Boletin Oficial, members of pre-paid health insurance plans will now be required to obtain prescriptions/treatment/consults/etc. solely from doctors in their cartilla medica in order to receive a discount/full coverage on prescribed medications or reimbursement for treatment/consults/medical studies unless the affiliate opts for the most expensive "open" prepaga plan.

What does this look like in practice? Let's say you can't get a turno with a cardiologist for 3 months because there are none available in your cartilla because OSDE pays them shit, so you paid out of pocket for a private turno. According to the article, it seems that not only will you not be able to get a portion of said turno reimbursed, now you won't even get the 40% medication reimbursement for your nitrates the doctor prescribed you because they aren't in your cartilla.


As for Monotributistas, well, now not only are you still required to have a prepaga/obra social, but you no longer have the right to join any one of your choosing as the government is making an opt-in for prepagas/obra sociales that are explicitly willing to take Monotributistas (hint, the most expensive ones). Previously you could denounce a prepaga/obra social to the Superintendency for refusing to allow you to join, but going forward, there will be a registry of them willing to take on new members. This may sound great, no more need to denounce the companies legally, but it's always been prepagas like OSDE which charge upwards for $400K/month for a single member that have been willing to take on Monotributistas who don't have 50%+ of their monthly income to spend on said plans.

What do I see in the future? The courts across the country being slammed with Amparo cases because these changes will violate numerous statues all in the name of lining the companies that consistency raise their monthly rates 100% above inflation, while providing less to their members.

Oh, and don't count on the public system, because it's crumbling across the country as people can no longer afford their private health insurance or lose their jobs.

https://www.laarena.com.ar/la-pampa...tes-en-salud-publica-es-enorme--2024102616520

VLLC!
 
The latest assault on Argentines' health, err, I mean "the caste" is brought to us by Javier Milei and Gabriel Oriolo, the former OSDE executive and millionaire that now runs the Superintendency of Health Services:


According to Resolution 3934/24 in the Boletin Oficial, members of pre-paid health insurance plans will now be required to obtain prescriptions/treatment/consults/etc. solely from doctors in their cartilla medica in order to receive a discount/full coverage on prescribed medications or reimbursement for treatment/consults/medical studies unless the affiliate opts for the most expensive "open" prepaga plan.

What does this look like in practice? Let's say you can't get a turno with a cardiologist for 3 months because there are none available in your cartilla because OSDE pays them shit, so you paid out of pocket for a private turno. According to the article, it seems that not only will you not be able to get a portion of said turno reimbursed, now you won't even get the 40% medication reimbursement for your nitrates the doctor prescribed you because they aren't in your cartilla.


As for Monotributistas, well, now not only are you still required to have a prepaga/obra social, but you no longer have the right to join any one of your choosing as the government is making an opt-in for prepagas/obra sociales that are explicitly willing to take Monotributistas (hint, the most expensive ones). Previously you could denounce a prepaga/obra social to the Superintendency for refusing to allow you to join, but going forward, there will be a registry of them willing to take on new members. This may sound great, no more need to denounce the companies legally, but it's always been prepagas like OSDE which charge upwards for $400K/month for a single member that have been willing to take on Monotributistas who don't have 50%+ of their monthly income to spend on said plans.

What do I see in the future? The courts across the country being slammed with Amparo cases because these changes will violate numerous statues all in the name of lining the companies that consistency raise their monthly rates 100% above inflation, while providing less to their members.

Oh, and don't count on the public system, because it's crumbling across the country as people can no longer afford their private health insurance or lose their jobs.

https://www.laarena.com.ar/la-pampa...tes-en-salud-publica-es-enorme--2024102616520

VLLC!
Mad props for the thread title 😃 now I need to do some deep reading.
 
The latest assault on Argentines' health, err, I mean "the caste" is brought to us by Javier Milei and Gabriel Oriolo, the former OSDE executive and millionaire that now runs the Superintendency of Health Services:


According to Resolution 3934/24 in the Boletin Oficial, members of pre-paid health insurance plans will now be required to obtain prescriptions/treatment/consults/etc. solely from doctors in their cartilla medica in order to receive a discount/full coverage on prescribed medications or reimbursement for treatment/consults/medical studies unless the affiliate opts for the most expensive "open" prepaga plan.

What does this look like in practice? Let's say you can't get a turno with a cardiologist for 3 months because there are none available in your cartilla because OSDE pays them shit, so you paid out of pocket for a private turno. According to the article, it seems that not only will you not be able to get a portion of said turno reimbursed, now you won't even get the 40% medication reimbursement for your nitrates the doctor prescribed you because they aren't in your cartilla.


As for Monotributistas, well, now not only are you still required to have a prepaga/obra social, but you no longer have the right to join any one of your choosing as the government is making an opt-in for prepagas/obra sociales that are explicitly willing to take Monotributistas (hint, the most expensive ones). Previously you could denounce a prepaga/obra social to the Superintendency for refusing to allow you to join, but going forward, there will be a registry of them willing to take on new members. This may sound great, no more need to denounce the companies legally, but it's always been prepagas like OSDE which charge upwards for $400K/month for a single member that have been willing to take on Monotributistas who don't have 50%+ of their monthly income to spend on said plans.

What do I see in the future? The courts across the country being slammed with Amparo cases because these changes will violate numerous statues all in the name of lining the companies that consistency raise their monthly rates 100% above inflation, while providing less to their members.

Oh, and don't count on the public system, because it's crumbling across the country as people can no longer afford their private health insurance or lose their jobs.

https://www.laarena.com.ar/la-pampa...tes-en-salud-publica-es-enorme--2024102616520

VLLC!
Yikes, thanks for the detailed info. There was a recent scandal here in Neuquen of rampant fraud by teachers getting various bogus "licencias" (authorizations for time off). So vast was the fraud, it amounted to an extra 2 weeks time off for every teacher in the Provincia in the past year. In one example, 3 doctors alone had distributed more than a thousand authorizations for time off for teachers in cities that were hundreds of kilometers from their practice. Many doctors involved lost their permit to practice and shortly after the teachers union was fighting a new law regarding the limits of days teachers can take off each month.
 
Mad props for the thread title 😃 now I need to do some deep reading.
Things keep getting worse, but hey, at least OSDE, Galeno, Sancor, etc. are going to have record profits this quarter!

Yikes, thanks for the detailed info. There was a recent scandal here in Neuquen of rampant fraud by teachers getting various bogus "licencias" (authorizations for time off). So vast was the fraud, it amounted to an extra 2 weeks time off for every teacher in the Provincia in the past year. In one example, 3 doctors alone had distributed more than a thousand authorizations for time off for teachers in cities that were hundreds of kilometers from their practice. Many doctors involved lost their permit to practice and shortly after the teachers union was fighting a new law regarding the limits of days teachers can take off each month.
It's unfortunate that people do things like this, but not surprising...
 
Yikes, thanks for the detailed info. There was a recent scandal here in Neuquen of rampant fraud by teachers getting various bogus "licencias" (authorizations for time off).
Do you recall the newspapers that reported this scandal? It sounds a bit like fake news floating around the social nets, with variations of the scam in every province. If true, It must have been one reason the fed debated this new resolution mentioned above which limits out of network doctor appointments.
 
Do you recall the newspapers that reported this scandal? It sounds a bit like fake news floating around the social nets, with variations of the scam in every province. If true, It must have been one reason the fed debated this new resolution mentioned above which limits out of network doctor appointments.

Here are a few links I found:



This is the law that the union fought against.

 
Here are a few links I found:
Thanks, unfortunate that things like that happen. I have never understood the need, in Argentina, for a Doctors note to prove the reason for a sick absence. Obviously it is needed for claims of longer term absence and disability, though for single day absences it shows that employees are treated like children. The proposed law you linked is a better way, giving a money reward for those who have 3 or less absence per semester.
 
Thanks, unfortunate that things like that happen. I have never understood the need, in Argentina, for a Doctors note to prove the reason for a sick absence. Obviously it is needed for claims of longer term absence and disability, though for single day absences it shows that employees are treated like children. The proposed law you linked is a better way, giving a money reward for those who have 3 or less absence per semester.
why would adult people (if they're not children, like you're saying) need to be rewarded for going to work, besides receiving their salary? the answer is one word "ñoquis" who need to be sacked, not encouraged. let them go hungry awhile, see what song they'll sing afterwards
 
Before jumping the gun and assuming (or wishing for…) the worst, would wait until you hear from your insurer to see if and how this resolution affects you. Here is what I just received:

“Hola:

Nos ponemos en contacto para informarte sobre la Resolución 3934/2024 de la Superintendencia de Servicios de Salud acerca de la validez de las recetas u órdenes de tratamientos en planes de salud cerrados.

Queremos llevarte tranquilidad y contarte que su alcance no afecta a los planes de OSDE, debido a que garantizan la libre elección de profesionales. Por lo tanto, tu cobertura no se modificará.

Para más información, podés acceder al texto completo de la disposición acá.

Ante cualquier duda o consulta, escribirnos por WhatsApp al 11.4872.9000, de lunes a viernes de 9 a 20 horas.

Saludos.

OSDE”
 
why would adult people (if they're not children, like you're saying) need to be rewarded for going to work, besides receiving their salary?
Every worker should be allocated some minimum number of "sick" days. People get sick, or their family gets sick, or some other errand task requires a day away from work that does not penalize without pay. Without that leeway, you have sick people in the workplace, or people not working at their best because of non-work thoughts and concerns. In this case described the government is suggesting 3 days per semester is reasonable. Basically that is calculated into the workers salary. The bonus reward is an extra if the worker does not take the days they should have taken off.
 
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