Unlike patients hire a private health policy addition to public health, officials who accept MUFACE (civilians), MUngeju (Ministry of Justice) and ISFAS (Armed Forces) access a private health coverage at the expense of giving up … The public.
This coverage has been lending DKV, Asisa and Adeslas so far for the beneficiaries of MUFACE and ISFAS. These three insurers are among those who hire Athes Health Bienzobas to manage their oncological coverage. In the case of the beneficiaries of Mugeju, these three insurers are added Sanitas -which also hires Athes for Oncology -Mapfre and Nueva Mutua. These last two have refrained from hiring this intermediary.
In 2024, a total of 1.6 million policies of officials and family members have been under the potential of Portes Health. Asisa about 564,000; DKV to about 217,000; and Sanitas at about 12,900.
Video: Thus tries to reduce the cost of cancer treatments
«Marginal clinical benefit»
This situation has turned the officials host of the health concert and their relatives in the most vulnerable in case of bad practices such as those who are denouncing reference oncologists about Atrys, since they cannot resort to public health.
In fact, in one of the medical reports that ABC has had access, the oncologist uses this argument against the Oncological Advisor of Ayths to try to turn the difficulties he put at the time of authorizing the proposed treatment for a patient. “Since this patient has no social security we are forced to maintain treatment according to international guides,” says the doctor, among other arguments.
The intermediary advisor put problems to that therapy ensuring that “it would not be valid” when “out of technical file.” The oncologist ratified himself in his decision explaining that both “the usual practice” and “all international guides” advised that therapy. The treatment was rejected.
The figure of the advisor who advises and authorizes
This company has become the main intermediary of insurers in the health sector for the treatment of cancer patients. When hired, the figure of the oncological advisor introduces, to which oncologists must request authorization for the treatments they want to prescribe.
Reaction to doctors’s requests
In the dozens of reports to which ABC has had access, this advisor does not authorize first treatments that are expensive but common in public health, and suggests another cheaper than doctors consider that it is less suitable for the patient in the stadium of his illness.
What happens if there is a dispute between the doctor and the advisor?
If the oncologist decides to ratify in his treatment sometimes the advisor gives up and accepts the therapy, and others insists on not authorizing and oncologists end up resorting to insurers to try to support their therapies.
If an official welcomed to the health mutual system discovers that in public health they could apply a treatment that they denied him in his concert, he must wait for January to exercise his right to free choice of health care.
There is an extraordinary way to manage changes but it is very complex and, above all, it is not immediate. In addition, the change must be approved by a Joint Commission of MUFACE, ISFAS or MUGEJU and public health, which values ​​whether the circumstances conform to the agreement.
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