The Supersalud revokes the operation of the EPS Medimás in four departments

The EPS Medimás will cease to operate in Antioquia, Nariño, Santander and Valle del Cauca because it does not provide the guarantees for the insurance and provision of health services for 731,421 members in these departments.

This was determined by the National Superintendence of Health through Resolution 012877 of November 12, 2020, in which it ordered the partial revocation of Medimás’ operating authorization in these departments, after showing that it jeopardizes the guarantee of effective access to health services. health, safety of members and the allocation of sector resources.

“After our monitoring, follow-up and evaluation actions, we found that Medimás presents the lowest levels in the guarantee of care compared to the provision of health services to the affiliated population in these four departments”said the National Superintendent of Health, Fabio Aristizábal Ángel.

Faced with this decision The Ministry of Health and Social Protection will be in charge of carrying out the process of transferring its affiliates to other Health Promoting Entities that do not have any surveillance measure and are duly authorized.

While the effective transfer of all affiliates in these departments is carried out, Medimás is obliged to guarantee the attention and access to health services in conditions of opportunity, accessibility, security, relevance and continuity; as well as the payment of the obligations with the providers and other suppliers of said departments.

This partial revocation It is the third that falls on this EPS in the last 14 months and with which it adds 15 departments where it stops operating as an insurer.

In September 2019, it was ordered to leave the departments of Cesar, Chocó and Sucre, where it had 52,555 members; and later, in June of this year, the same measure was ordered for the departments of Atlántico, Arauca, Bolívar, Cauca, Cundinamarca, Guainía, La Guajira and Magdalena, where it had 319,223 users.

The distribution of the 731,421 Medimás affiliates covered by the current measure corresponds to Antioquia 214,626 users, Valle del Cauca 259,111, Santander 175,278 and Nariño 82,406.

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The Supersalud carried out an analysis of the number of petitions, complaints, claims and reports (PQRD) that it received from the users of the System in these departments, establishing that during 2019 and the first semester of 2020, Medimás ranked first in the contributory regime and second place in the subsidized scheme, respect

to the total EPS.

In Nariño there were cases of children diagnosed with cancer, for whom the EPS did not guarantee care and had to wait up to 135 days for a response regarding health care.

Regarding the department of Santander, cases were identified where patients had to wait up to 400 days for the supply of the necessary medicines and supplies, and up to 11 months to receive a response to their PQRD.

In Valle del Cauca, cases of patients were identified that took up to 152 days to guarantee access to effective care with the specialist doctor.

During a visit to the department of Antioquia, the Superintendency documented cases of diabetic patients who waited up to 325 days for their insulin to be delivered.

During 2019 and the first months of 2020, there were delays in the allocation of specialized medicine appointments, lack of opportunity in the provision of health services, non-compliance when supplying drugs and supplies, hiring providers that did not have authorized services, and failures in the operation of the referral and counter-referral system, among others.

Monitoring by the Superintendency showed that EPS Medimás had repeated non-compliance in payments to providers in the four departments, since it did not make the timely transfer of resources for obligations for health services and technologies.

According to reports that the EPS itself made to Superhealth, by June 2020 it accumulated with its provider network of these departments a total portfolio of $ 354,512 million, while the portfolio with a maturity greater than 180 days went from $ 37,794 million in June 2019 to $ 117,046 million in June 2020, which represented an increase of 210%; taking into account this existing portfolio, a possible risk of illiquidity is warned.

In the financial aspect, Medimás indicators in these four departments show a recurring non-compliance in items such as: gloss reconciliation percentage, level of indebtedness, minimum capital, adequate equity, investment of technical reserves, current ratio, percentage of filing of recoveries , portfolio collection percentage and portfolio collection behavior, among others.

In the 10 days following the notification of this measure, Medimás must present to the National Superintendency of Health a schedule to be executed in a term not exceeding three months with the activities to reconcile, purify and pay the portfolio with the Provider Institutions of Public and private health services and with providers of health services and technologies.

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