How to File Complaint with Colombia's SuperSalud

The Superintendencia Nacional de Salud (SuperSalud Colombia) is the federal body that regulates all EPS (Empresas Promotoras de Salud) in Colombia. When your EPS denies a health claim, delays care, or violates your PBS (Plan de Beneficios en Salud) rights, SuperSalud has authority to investigate, compel EPS responses, and impose sanctions. This guide explains exactly how to file and what to expect.

What SuperSalud Colombia Can Do

SuperSalud Colombia's authority includes:

• Ordering EPS to authorize denied PBS services: If SuperSalud finds a PBS violation, it can instruct your EPS to cover the denied service
• Imposing administrative fines: EPS that systematically violate PBS coverage rights face significant financial penalties
• Disciplinary proceedings: SuperSalud can initiate disciplinary action against EPS managers for repeated violations
• Monitoring compliance: SuperSalud tracks EPS performance data and can intervene in EPS operations for systemic failures
• Facilitating conciliation: For some dispute types, SuperSalud facilitates conciliation between the EPS and the member

SuperSalud is accessible online at supersalud.gov.co through its Oficina Virtual (Virtual Office).

When to File With SuperSalud Colombia

File a SuperSalud complaint when:

• Your EPS denied a service you believe is PBS-covered and your derecho de petición was ignored or inadequately answered
• Your EPS failed to respond to your derecho de petición within 15 business days (10 for urgent matters)
• Your EPS is systematically denying a type of service (not an isolated incident)
• You want an official regulatory investigation alongside (or instead of) a tutela
• You were charged copayments or fees that are not permitted under the PBS

Note: For urgent medical situations, file a tutela immediately in addition to your SuperSalud complaint — the tutela resolves in 10 days, while SuperSalud's process takes weeks.

What You Need Before Filing

Gather the following before starting your complaint:

1. Cédula number — your Colombian national ID
2. EPS name and affiliation number
3. Written denial from your EPS — request it in writing if you have not received it
4. Medical order (orden médica) — your physician's written prescription or referral for the denied service
5. Clinical records — diagnosis, test results, medical history
6. Your derecho de petición (if filed) and the EPS response
7. Any relevant PBS documentation — the PBS service category applicable to your case

How to File Your SuperSalud Complaint

Step 1: Go to supersalud.gov.co

Navigate to the official SuperSalud website. Look for "Oficina Virtual" or "Reclamos / Quejas" in the main navigation.

Step 2: Create or Access Your Account

Register with your cédula number and contact details to access SuperSalud's complaint portal. If you have filed previously, log in to your existing account.

Step 3: Select the Complaint Category

SuperSalud categorizes complaints by the nature of the dispute:

• Queja por negación de servicios: Denial of PBS-covered services
• Queja por incumplimiento de timelines: EPS failed to respond within legally mandated periods
• Queja por cobros inapropiados: Improper charges or copayments
• Queja por mala calidad del servicio: Quality of care issues
• Queja por no afiliación: Enrollment or affiliation disputes

Select the category most relevant to your situation. For claim denials, use "negación de servicios."

Step 4: Complete the Complaint Form

The form will ask for:

• Your personal details (auto-filled from your account)
• Name of the EPS
• Your EPS affiliation number
• The service, medication, or procedure denied
• Date of denial and the reason given by the EPS
• What outcome you are requesting
• A factual narrative of the dispute

Be specific. Reference the PBS service category. State clearly: "My EPS [Name] denied [specific service] on [date], citing [stated reason]. This service is PBS-covered under [relevant PBS category]. I request that SuperSalud order my EPS to authorize this service."

Step 5: Upload Supporting Documents

Attach digital copies of:

• EPS denial letter or confirmation
• Your medical order (orden médica) from your physician
• Clinical records and diagnosis documentation
• Your derecho de petición and EPS response (if applicable)
• PBS reference documentation (printout of the relevant PBS category from minsalud.gov.co)

Step 6: Submit and Record Your Reference Number

After submission, you receive a reference number (radicado). Record this number — it tracks your complaint status and is required for follow-up communications.

What Happens After You File

EPS notification: SuperSalud formally notifies your EPS of the complaint, requiring a formal written response within 15 business days.

SuperSalud review: A SuperSalud case officer reviews the complaint, the EPS response, and supporting documentation. They may request additional information from either party.

Resolution: SuperSalud can:

1. Order coverage: Direct the EPS to authorize the denied PBS service
2. Impose sanctions: Fine the EPS for PBS violations, disciplinary proceedings for managers
3. Conciliation: Facilitate an agreement between you and the EPS
4. Close without action: If the denial is found to be within the EPS's legal rights (rare for PBS violations)
5. Refer to investigation: Open a broader investigation into the EPS for systemic violations

Timeline: Routine complaints typically take 30-60 business days. Urgent cases where you explicitly note the medical urgency may be processed faster.

Tips for a Successful SuperSalud Complaint

• Reference PBS specifically: Go to minsalud.gov.co and find the PBS service list. Name the specific PBS category your service falls under.
• Note urgency explicitly: If the denial involves active treatment or deteriorating health, state this clearly in your complaint and request urgent processing.
• File simultaneously with tutela for urgent cases: A SuperSalud complaint and a tutela are not mutually exclusive — file both.
• Follow up at 15 business days: If you have not received any communication from SuperSalud after 15 business days, contact their Mesa de Ayuda with your radicado number.
• Defensoría assistance: If you are not comfortable navigating the online system, your regional Defensoría del Pueblo office can assist with filing.

What SuperSalud Cannot Do

SuperSalud cannot:

• Award you financial damages beyond ordering reimbursement of denied PBS costs
• Resolve disputes faster than the tutela (10 days) — use tutela for urgencies
• Handle disputes with private insurance providers that are not EPS (those fall under Superintendencia Financiera)

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Related Reading:

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal