Home Health The importance of having a private health plan

The importance of having a private health plan

by Lisa Baker

The limitation that EPS places on general practitioners to refer patients to their specialist colleagues is already public knowledge. That is, they are forced to carry out any treatment regardless of whether or not it is within their competence. In most Private Health Plans, it is the patient who decides when and to which specialist to go. So suddenly your assessment is wrong since it could happen, for example, that someone requests an appointment for the neurologist and he or she results in referring to the ophthalmologist if he finds that the condition, in this case a recurrent headache, has nothing to do with his specialty rather it is caused by vision problems. Surely the patient will not bother having to go to a second appointment because it is better that they have enough and not that they lack options.

When it comes to diagnostic tests, these are usually scarce at the first consultation since, almost always, the way out for doctors is to prescribe ibuprofen. When he is the doctor of the private plan, he has no problem in requiring the diagnostic aids that he considers necessary to rule out pathologies and thus establish the most indicated treatment.

It is also known of the eternal wait that a user implies for his eps to authorize a scheduled surgery. In the private plan, it is enough that the doctor of your order and, if it is not a pre-existing one, the company issues authorization, although in some cases committees are required that exhaustively study a case if they have doubts and then give it the go-ahead. It is here where EPS and private plans are complemented since the former, by law, do not exclude pre-existence or congenital diseases. Although some private plans already include them in their coverage.

Except for possible delays that imply the classification of triage in emergency consultations, attention times, in general, in private plans are shorter due to the smaller number of people who demand the service and due to the range of possibilities in terms of clinics that contemplate private plans, which include not only their own medical centers and clinics but also contract with other private clinics and the best hospitals, which becomes a network of clinics and medical centers of free choice for the member.

In Colombia, many of the private health plan companies have contributed with hospital infrastructure and medical centers, thus helping to partially reduce the deficit and deficiencies of the public health system that we already know is going through its worst crisis.

I have heard many times from users of these private plans who recovered in a treatment of some disease, catastrophic or not, in an emergency or hospitalization in intensive care everything and more than they paid, preventively, for many years. In other words, they consider that it was worth the effort of having paid for the private plan that they never knew when they were going to need it.

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