ASES gives First Medical until Aug. 1 to pay service providers or risk contract cancellation

Health Insurance Administration Executive Director Roxanna Rosario Serrano, center

By The Star Staff

Health Insurance Administration (ASES) Executive Director Roxanna Rosario Serrano has given First Medical until Aug. 1 to pay service providers of the Vital health plan, which is the island’s public health insurance plan, monies owed to them or risk having its contract canceled.

“Any supplier who has not received payment must file a complaint with ASES to initiate the due processes and protect those funds,” Rosario said. “Regarding the insurance company, we must have been supervising the insurance company’s payment for services, which is why we are in this situation. We identified the problem. We issued communications to First Medical, and we have given them until August 1 to comply with the payment requirement in the contract, served by the Code of Federal Regulations for Medicaid funds.”

The official reiterated that patients experiencing difficulties with their current insurer have the right to switch to another provider, such as Triple S, the Menonita Health Plan, or MMM. That guidance empowers patients to take control of their healthcare options, she added.

If First Medical fails to meet the Aug. 1 deadline, it could face severe penalties, including a complete halt to its affiliations and potential contract cancellation, the official said. Those consequences, as outlined, underscore the seriousness of the situation and the need for First Medical to fulfill its obligations, Rosario said.

The head of ASES noted that of the 290,000 Vital patients insured under First Medical, at least 800 have dropped out to go with another insurer.

“We are talking on average of 136 changes per day in the last working days in July,” she said “[…] In these calls, we have identified the volume of suppliers and the specialties of suppliers not providing service. Their contract is active, but they are not providing service. We have to ensure that the beneficiary has service, then, with another insurer,” she indicated.

Rosario added that ASES has remained in communication with First Medical and has given it time so that the meetings will continue. She said the group has been open about the plan to be executed.