The Constitutional Court Rules Prepaid Medicine Companies Cannot Deny Psychological and Neurological Therapies
In a landmark decision, the Constitutional Court has established that prepaid medicine companies cannot deny psychological and neurological therapies in their complementary plans. This ruling came as a warning to Colsanitas and the EPS Sura, after they rejected the request of a girl who required this service previously prescribed by the doctor of the same entity.
The Court also criticized Colsanitas for using constitutionally problematic clauses to deny the request, specifically excluding treatments originating from congenital diseases. The EPS Sura similarly denied the request, alleging that it had not been prescribed by a doctor within their network of providers.
The mother of the minor in question sought to protect her daughter’s right to health, but a lower court initially denied the claims, citing contractual disputes. However, the Ninth Review Chamber, with a presentation by Judge José Fernando Reyes Cuartas, revoked this determination and instead protected the rights of the girl.
The Constitutional Court found that Colsanitas violated the minor’s right to health by interrupting treatment based on purely administrative or contractual reasons, ignoring the principle of continuity in health. The company was also criticized for failing to fulfill its duties regarding the exercise of its economic activity and including contract clauses contrary to the Constitution according to constitutional jurisprudence.
As a result of the ruling, the Court ordered Colsanitas to review its contractual regime in light of the parameters established in constitutional jurisprudence. Specifically, the company was directed to modify the model adhesion contract and adopt a clear, precise, and accelerated plan to adjust all its contractual and administrative practices to the rules established in the ruling.