What will happen to the health of more than 1.2 million EPS Coomeva affiliates?

Interviewed credits:

Felipe Negret – Liquidating Agent of Coomeva

Lina María Aldana – Comptroller Delegate for the Health sector

RPTV NEWS AGENCY team:

Journalist: Edgar Ramirez

Camera and Edition: Oscar Cavadia

BOGOTA COLOMBIA). Tuesday, February 15, 2022 (RPTV NEWS AGENCY). Due to the liquidation of EPS Coomeva ordered in January this year. Many users are not sure what will happen to some of the services provided by this EPS.

“What is going to happen to people who have cancer?” Questions like these that are formulated by patients like Karen Olmos, are the questions asked by citizens affiliated with Coomeva EPS, after the National Superintendence of Health ordered the liquidation.

Given the users’ drama, the EPS settlement agent, Felipe Negret, explained the process that is being carried out with the users.

“They have already received an email that tells them which EPS corresponds to them. From then on, the receiving EPS is the one that is obliged to provide the service, the medicine, the treatment”, Negret clarified.

And in the case of the Compliance Audit, all the resources that were executed in the 2021 term are reviewed, putting the magnifying glass on the contractual and financial administrative operations.

“In the audit that we carried out in 2020, we found more than 7,000 million pesos in fiscal findings and for the year 2021 we found more than 17,000 million pesos,” said Lina María Aldana, Comptroller Delegate for the Health sector.

In this sense, the control body indicated that permanent monitoring will continue to accompany the entire liquidation process, reviewing the execution of the public resource, so as to verify that no patrimonial damage is going to occur.

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2021

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Coomeva: affiliates ask that health problems not continue with new EPS - Cali - Colombia

In a queue since dawn, in the south of Cali, Rodrigo Caicedo waited for a way out of the drama of his wife, who suffers from a progressive brain disorder. For the last year, she has had a hospital at home, but now the couple suffers from uncertainty.

Two weeks ago, when Coomeva EPS came to an end, Caicedo began looking for someone to tell him how to do so that he would not be removed from the care program and would have a nurse, a request that was pending. “I am going to ask that they not unprotect me,” says Caicedo, noting that the procedures are complicated.

(Also: Debts to hospitals and patients left by Coomeva in Antioquia are worrying)

It is one of the stories that have been lived by the liquidation of the EPS, adopted by the Superintendence of Health pointing out “the impossibility of correcting the critical financial situation in which it finds itself and as protection of the life and health of its 1.2 million affiliates in 24 departments of the country.”

Although the Ministry maintains that users were transferred to 14 entities, the blow is hard in Valle del Cauca, where there were 400,000 members; of them, 180,000 are in Cali. In the same week, Supersalud intervened in Emssanar EPS, which had 967,946 members in Valle del Cauca.

If they don’t give me the medicine every day, they can give me a seizure

The Secretary of Health of the Valley, María Cristina Lesmes, says that it is a blow to the public network in the department. Both entities, with more than 3 million users in the country, concentrate a large part of their affiliates in the southwest. Users of the liquidated EPS Coomeva seek guidance at the offices of the Health Secretariats of the Valle del Cauca capital and the department.

(Also read: Alarm from the Governor of the Valley due to EPS intervention)

That is the case of Gloria Guanene, 61 years old. The woman from Cali aspires not to have to go to more guardianships, as she has been doing for four years, nor to be begging every month for therapies, after a tumor was detected on the right side of her brain. Her abnormal mass pressed against his frontal and temporal lobes.

This patient says that four years ago they removed the tumor from her head, extracting a part of her brain. But she was left with convulsive syndrome. She claims that she has since come on her fight to continue to pay attention. “If they don’t give me the medicine every day, they can give me a seizure”, he says from a wheelchair, as he lost the mobility of his right leg and arm.

Now his new struggle has been to be assigned an appointment at the new EPS that was assigned to him on the website of the Ministry of Health and thus continue with his treatment. “We don’t know whether to be happy with the change or to worry,” says Ximena Marín, whose father, Guillermo Marín, has esophageal cancer. And her father is confined in a clinic in the south of Cali. “In Coomeva they were processing the hospital program at home, but now, with this change, we don’t know what will happen to it.”

It is a very serious situation that additionally affects a network of service providers that have lived from this entity, for 26 years, serving its population.

(Keep reading: Users of Coomeva EPS in liquidation go to 14 entities)

The Secretary of Health of Cali, Miyerlandi Torres, explains that in the case of patients with high-cost illnesses, each EPS to which the affiliates who came with Coomeva EPS are being assigned must guarantee that the health-providing institutions (IPS), such as clinics and hospitals, and who were already treating them, do not interrupt care. She points out that this was the commitment of these entities.

It notes that those who had filed guardianship actions, when they were affiliated with Coomeva EPS, must go to the offices of the assigned insurance entities or EPS so that these bodies can initiate the respective procedures and thus provide the required attention in the IPS.

According to the Secretary of Health of the Valley, the loss of Coomeva EPS “is a very serious situation that additionally affects a network of service providers who have lived from this entity, for 26 years, attending to its population”. And he adds that there is a social and economic impact, because 7,900 workers are laid off.

(You may be interested in: Barranquilla: Personería watches over the transfer of people with disabilities)

CAROLINA BOHORQUEZ
Correspondent of THE TIME
Cali