Abuso de seguros de salud en Colorado

Explicación Simple

Si un médico acepta un pago de un seguro que es más bajo de lo que le cobraría a un paciente, eso está mal. También es incorrecto si cobra más de lo que acordó con el paciente y luego no le pide que pague su parte.

Es como si en un juego de fútbol, un jugador acordara jugar por un precio y luego pidiera más dinero a un patrocinador, sin que el jugador lo supiera. Eso no es justo.

Ejemplo Práctico

Imagina que la doctora Ana atiende a su paciente Luis. Luis tiene un seguro que cubre $100 por la consulta. Ana, sin que Luis lo sepa, acepta $80 del seguro como pago completo, cuando en realidad le había dicho a Luis que le cobraría $60. Esto sería abuso de seguro.

Penalidades

El abuso de seguros de salud es considerado una falta menor.

Texto Original del Estatuto (Inglés)

y the patient of any required deductible or copayment applicable in the patient’s health benefit plan, a person who provides health care commits abuse of health insurance if the person knowingly: (a) Accepts from any third-party payer, as payment in full for services rendered, the amount the third-party payer covers; or (b) Submits a fee to a third-party payer which is higher than the fee he has agreed to accept from the insured patient with the understanding of waiving the required deductible or copayment. (4) Abuse of health insurance is a petty offense. (5) Intentionally left blank —Ed. (a) Reimbursements made pursuant to articles 3 to 6 of title 25.5, C.R.S., federal medicare laws for inpatient hospitalization, and mental health services purchased in accordance with article 66 of title 27 , C.R.S., are exempt from the provisions of this section. (b) Health-care services are exempt from the provisions of this section if such health-care services are provided: (I) In accordance with a contract or agreement between an employer and an employee or employees and the contract includes, as a part of an employee’s salary or employment benefits, terms that authorize a practice that would otherwise be prohibited by subsection (3) of this section; or (II) In accordance with a contract or agreement between a town, city, city and county, or municipality or a special health assurance district pursuant to section 31-15-302 (1), C.R.S., under terms that authorize a practice that would oth