The executive director of the Puerto Rico Health Insurance Administration (ASES), Jorge Galva explained today what is a referral and a medical order before the registry today of 17 calls from beneficiaries.
“It is important that the patients know the difference between referral and medical order, "Galva explained.
As indicated, a referral is established by the Managed Care Model that establishes a methodology for beneficiaries to receive specialized services. "In this case, it is the Primary Physician -as part of the insurer's requirements within a coordinated care system that evaluates and approves said service, whether it be laboratories, specialist or subspecialist physicians, radiologies, among others."
On the other hand, the medical order is the one made by any doctor who has a contract or not as a provider with one of the insurers attached to the Government Health Plan, Vital. “In this way, any private doctor has the option of attending to Plan Vital beneficiaries traditionally or virtually and can even send the patient electronically to maintain physical distance.”
In addition, Galva clarified that by federal mandate the Order Medical must be presented by the patient as usual if they are going to request services of laboratories and radiologies, among others.
ASES has about 1.2 beneficiaries assigned to the Vital Plan and the affiliated insurers are: First Medical, Mennonite Health Plan, Triple S and MMM and Molina Healthcare.