How to file a claim before the Superintendence of Health for problems with a prepaid health insurance company or health insurance company.

The Superintendence of Health is the agency in charge of overseeing compliance with the rules of the health system, so members who wish to file a claim with a prepaid or social security company must do so through it.

The purpose of the Superintendence of Health is to protect the rights of users, promote the quality of health care, supervise and control the entities of the health system and resolve disputes between members and the entities.

How to make a claim before the Superintendence of Health?

Before filing a claim with the Superintendence of Health, members must file a complaint with their health insurance company.

If the health entity does not provide solutions or rejects the complaint, users can file a complaint with the Superintendence of Health Services within 10 working days.

The first step to file a complaint with the agency is to complete the complaint form.

Then, members must choose one of the alternatives to continue with the claim.

The first option is to do it through the Tramites a Distancia (TAD) website. This platform allows the citizen to carry out procedures before the Public Administration virtually from a computer, being able to manage and follow up on them.

The steps to start the claim in the TAD site are as follows:

• Search for"Superintendencia de Servicios de Salud" in the search engine.
• Search and select the required procedure, the claims can be found under the name"Presentation of beneficiary claims".
• Choose whether to initiate the procedure with Mi Argentina or with AFIP. For both options it is necessary to have a user and fiscal code level 2.
• Fill in your personal data
• Confirm the data and click on "Continue".
• Attach the required documentation
• Confirm the procedure
• In the windows on the left you can view the files and notifications.

On the other hand, you can request an appointment to carry out the procedure in person. The appointment can be made online through Mi Argentina or by calling 0800-222 SALUD (72583).

Finally, it is possible to send the documentation by mail:

• To the Head Office: Bartolomé Mitre 434 - Ground Floor - CABA - C1036AAH
• To the Delegation closest to the member's address.

Within 48 hours after the claim has been filed, the Superintendence of Health will transfer it to the corresponding pre-payment or social security company so that they comply with the requirements claimed by the affiliates.

Within the following ten working days, the social security or prepaid health insurance company must respond to the claim. If the response is not satisfactory, the affiliate may request the intervention of the Superintendence of Health, which must resolve it within 30 working days.

The Superintendence of Health may consider the claim valid and order the social security or prepaid health insurance company to comply with what is required, reject the user's claim or issue a resolution that is not entirely favorable to either party.

If the affiliate who initiated the claim is not satisfied with the resolution issued by the agency, he/she may file an appeal for reconsideration within ten days from the date of notification of the resolution or initiate legal action.

What documentation is required to initiate a claim?

In order to file a claim against a social security or prepaid health insurance company, the following documentation must be submitted to the Superintendence of Health:

• Claim form signed by the holder or, in case of urgency, by unofficial manager, ratified within 30 days.
• Photocopy of the holder's ID card
• Photocopy of CUIL or CUIT
• Photocopy of the Social Security card or Prepaid card
• Photocopy of the last pay stub, or labor certification issued by the current employer (Model or payment of monotributo, or payment of domestic service, payment of prepaid medicine entity fee, or receipt of social security benefits (retirement or pension):
  • Monotributo F184/F152 AFIP, registration as a social monotribute and as an effector of the Ministry of Social Development.
  • Domestic Service F102 AFIP and in case of adherents F575. AFIP
• If it is for the family group: Photocopy of the ID card, photocopy of the Social Security or Prepaid card of the dependent person and document proving the relationship (birth certificate, marriage certificate, cohabitation certificate).
• Updated medical prescription: Summary of medical history and justification of the benefit by a physician.
• In case of Disability Problems: Photocopy of Disability Certificate (CUD).
• Note from the provider in the event of a cut-off of services due to Social Security debt.