Cargos por Tratamiento Médico No Necesario

Explicación Simple

Si un médico te hace un tratamiento que no necesitas, no puedes tener que pagar por ello. Si ya pagaste, el médico debe devolverte el dinero con interés. No te preocupes, no es tu culpa si el tratamiento fue innecesario.

Es como si un amigo te vende un coche que no funciona y luego te dice que tienes que pagar por él. Si resulta que el coche estaba roto desde el principio, él debe devolverte el dinero, no tú a él.

Ejemplo Práctico

Imagina que Juan va al médico por un dolor de espalda. El médico le recomienda una cirugía que no era necesaria. Después, se determina que la cirugía no era necesaria y el médico debe devolverle a Juan el dinero que pagó, más intereses.

Texto Original del Estatuto (Inglés)

(7) Determination in favor of insurer.--If it is determined by a PRO or court that a provider has provided unnecessary medical treatment or rehabilitative services or merchandise or that future provision of such treatment, services or merchandise will be unnecessary, or both, the provider may not collect payment for the medically unnecessary treatment, services or merchandise. If the provider has collected such payment, it must return the amount paid plus interest at 12% per year within 30 days. In no case does the failure of the provider to return the payment obligate the insured to assume responsibility for payment for the treatment, services or merchandise. (c) Review authorized.--By December 1, 1991, the Legislative Budget and Finance Committee shall commence a review of the impact of this section. Such review may be conducted biennially. (Feb. 12, 1984, P.L.53, No.12, eff. Oct. 1, 1984; Feb. 7, 1990, P.L.11, No.6, eff. Apr. 15, 1990) References in Text.The act of July 3, 1985 (P.L.164, No.45), known as the Emergency Medical Services Act, referred to in subsec. (a), was repealed by the act of August 18, 2009 (P.L.308, No.37). The subject matter is now contained in Chapter 81 of Title 35 (Health and Safety). Cross References.Section 1797 is referred to in section 1712 of this title. 75 Pa.C.S. 1984 - Amendment References in Text.Subchapter F, referred to in this section, is repealed. 75 Pa.C.S. 1989 - Amendment References in Text.Section 315 of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of 1921, referred to in subsec. (a), was repealed by the act of December 18, 1992 (P.L.1496, No.177). Cross References.Section 1798.1 is referred to in section 1798.2 of this title.