The new ADSE price list prompted Hospital da Luz to drop some of the services and clinical acts from the agreement, creating a special price list for uncoordinated actions, the health group said in a statement.
The Hospital da Luz network will maintain “general agreements” with ADSE, the private health group said in a statement released today, clarifying that, however, following an evaluation, it concluded that for some services: clinical acts, a new a price list “approved by the ADSE does not adequately assess” the costs associated with its “clinical standards” as well as the work of professionals.
“This fact has left Grupo Luz Saúde with no other alternative than to exclude from the scope of the convention these services / clinical activities in the branches of the Hospital da Luz network,” the statement said.
The new ADSE network price list is due to take effect this Wednesday, September 1, and will also apply to other public health subsystems, namely IASFA, SAD-PSP and SAD-GNR – military and security.
Grupo Luz Saúde adds that it has reorganized its care offering to support users of these health subsystems, at least in part of the Hospital da Luz branch network.
Thus, and “to mitigate the financial impact of the new table, Hospital da Luz’s network customers who are beneficiaries of ADSE, IASFA, SAD-PSP and SAD-GNR will have access to a dedicated service pricing table. / inconsistent clinical actions “, the prices of which” correspond “to the prices applied by the insurers.
According to this special price list, the statement says that a consultation with a specialist doctor who does not have an agreement with the public administration workers ‘and retirees’ subsystems will cost beneficiaries between 35 and 40 euros, “then the recipient can claim reimbursement.”
The new ADSE tables update the cost of consultations in the agreed network, changing the recipient’s fee to five euros (versus the current 3.99 euros), and the amount reimbursed by the ADSE increases from 14.47 euros to 20.
In addition to this price update, which aims to strengthen the coherent network by avoiding recourse to a free regime, the revision of the tables includes new medical acts and suppresses others that were outdated, and sets maximum limits for thousands of surgical procedures, hospital drugs and prostheses.
