Si te lastimas en un accidente de auto, los médicos no pueden cobrarte más del 110% de lo que normalmente cobrarían. Esto asegura que los costos sean justos y no excesivos.
Es como cuando vas a comprar un refresco; no pagas más de lo que cuesta en la tienda, y si el precio sube, solo se permite un pequeño aumento, pero no demasiado.
Imagina que Juan tuvo un accidente de auto y necesita tratamiento médico. El hospital le dice que el costo del tratamiento no puede exceder un cierto límite, basado en lo que normalmente se cobra en su área. Así, Juan solo paga lo justo y no un precio inflado.
(a) General rule.--A person or institution providing treatment, accommodations, products or services to an injured person for an injury covered by liability or uninsured and underinsured benefits or first party medical benefits, including extraordinary medical benefits, for a motor vehicle described in Subchapter B (relating to motor vehicle liability insurance first party benefits) shall not require, request or accept payment for the treatment, accommodations, products or services in excess of 110% of the prevailing charge at the 75th percentile; 110% of the applicable fee schedule, the recommended fee or the inflation index charge; or 110% of the diagnostic-related groups (DRG) payment; whichever pertains to the specialty service involved, determined to be applicable in this Commonwealth under the Medicare program for comparable services at the time the services were rendered, or the provider's usual and customary charge, whichever is less. The General Assembly finds that the reimbursement allowances applicable in the Commonwealth under the Medicare program are an appropriate basis to calculate payment for treatments, accommodations, products or services for injuries covered by liability or uninsured and underinsured benefits or first party medical benefits insurance. Future changes or additions to Medicare allowances are applicable under this section. If the commissioner determines that an allowance under the Medicare program is not reasonable, he may adopt a different allowance by regulation, which allowance shall be applied against the percentage limitation in this subsection. If a prevailing charge, fee schedule, recommended fee, inflation index charge or DRG payment has not been calculated under the Medicare program for a particular treatment, accommodation, prod
No pueden cobrarte más del 110% de lo que normalmente se cobra en el área por ese tratamiento, asegurando que los costos sean razonables.
Si no hay un precio claro bajo el programa Medicare, el costo no puede exceder el 80% de lo que el proveedor usualmente cobra.
Sí, si hay cambios en los costos establecidos por Medicare, esos nuevos límites se aplicarán automáticamente.
¿Necesita ayuda para analizar su caso?
Seguir Investigando →