health
Bought medicine on your own? Step-by-step guide for your EPS to refund you
In Colombia, paying out of pocket for medications, consultations, or medical exams has become a reality for many. However, what few know is that this money can be claimed. It is not a favor, but a right backed by law.
TL;DR
- EPS affiliates in Colombia can claim refunds for medical expenses paid out-of-pocket due to system failures.
- Situations eligible for reimbursement include lack of specialists/services, unjustified denials, and paying for authorized items like medication.
- To claim, gather proof of payment and medical history, then file a formal request (derecho de petición) with the EPS.
- The reimbursement amount varies and is subject to system tariffs and case-specific analysis.
- If the EPS does not respond or the response is unsatisfactory, individuals can escalate to entities like the Superintendencia Nacional de Salud or file a 'tutela'.