July 29, 2021

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Government Health Plan Beneficiaries Will Not Need Medical Referrals During Coronavirus Emergency

Governor Wanda Vázquez Garced reported that the 1.2 million beneficiaries of the new Vital Health plan will not need a referral to receive medical services, laboratories, radiologies, and hospital services.

“Given the increase in positive cases in the COVID-19 reported by the Health Department, a regulatory letter was issued to insurers and to Managed Care Organizations (MCO's) and service providers in which it establishes that immediately effective patients or beneficiaries of the Vital plan will not have to request and submit referrals to receive medical services, laboratories, radiologies and hospital services, "said Vázquez Garced in written statements.

This instruction was sent today through the executive director of the Health Insurance Administration (ASES), Jorge Galva, and the secretary of the Department of Health and president of the Board of Directors of ASES, Lorenzo González. [19659002] The Secretary of Health indicated that: “With this measure we guarantee adequate access and the norm to protect the health of the beneficiaries of the Vital Plan. Any beneficiary who understands that this standard has not been complied with, contact the ASES Compliance Office (Tel. 787.474.3300) and if the aforementioned is validated, the insurer is exposed to fines of thousands of dollars. ”

On the other hand, Galva emphasized that “it is important to mention that those services that are not currently on deck cannot be authorized under the Vital Plan. This policy will be in force until the ASES suspends this regulation. "

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