Your rights as a patient: what the Bill of Rights says

It is a law of general application over medical-hospital health services in Puerto Rico: it applies to patients, users and consumers of those services and to those who provide them — insurers, health plans, health professionals and facilities. It is not a pamphlet of good intentions: the law obligates providers to keep copies of the Bill available for patients to inspect, and to require that you read and familiarize yourself with it (or a summary authorized by the Health Department) before signing any services contract, recording that the requirement was met.

Every patient, user or consumer of medical-hospital health services in Puerto Rico. There is nothing to register for and no income qualification: the rights exist by law from the moment you seek or receive health services, and they apply against your health plan, the professional treating you, and the facility treating you.

• None: the Bill’s rights apply to every patient, user or consumer of medical-hospital health services in Puerto Rico.Verified against the official source

• To claim: the written notice of the denial, limitation or termination of services your plan is obligated to give you, with its grounds and the appeal mechanisms.
• To access your information: the request for your medical record, whose access and confidentiality the law expressly protects.

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   Step 1: The emergency: the most violated right

   You have the right to free, direct and unrestricted access to emergency services and facilities when and where the need arises, regardless of your socioeconomic condition and ability to pay, and no plan may deny you payment or coverage of an emergency. Emergency services are provided with no waiting period and no prior authorization from the insurer, even if the provider is out of network. If a non-contracted provider treated you, you are not responsible for paying more than you would have with a contracted provider: the insurer compensates the provider and the provider is obligated to accept that compensation.

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   Step 2: Before choosing: information to decide

   The law gives you rights over obtaining and disclosing information and over selecting plans and providers: reliable, detailed information to choose, including — for emergencies — the availability, location and appropriate use of your area’s emergency facilities and the payment and recovery rules. It is exactly the information you rarely get unless you ask.

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   Step 3: During treatment: you decide, with your information

   The Bill recognizes rights regarding participation in decision-making about your treatment, respect and equal treatment, continuation of health care services, and confidentiality and access to your medical records. If you are about to decide something big, ask in writing for whatever you do not understand: the law exists precisely so the decision is yours and informed.

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   Step 4: If you are denied: demand the letter and appeal

   You have the right to timely written notice of every decision to deny, limit or terminate services or refuse payment, including the grounds and the mechanisms to appeal. The internal appeal must be resolved promptly — and expeditiously if it involves urgent or emergency care, within Medicare’s parameters. The review is done by qualified professionals who did not take part in the initial decision, and at the end you must receive written notice with the grounds and the external remedies available. External review applies once you have exhausted internal remedies.

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   Step 5: If none of that works: the complaint

   The law gives you the right to simple, fair and economical mechanisms to resolve differences — even about waiting times, hours of operation, staff behavior and facility conditions — and to external supervision of those mechanisms. When the problem is not resolved with the plan or provider, the route is a complaint before the Office of the Patient Ombudsman; PRFácil has a dedicated guide for that procedure.

There is no filing: these are rights that apply by law. Providers are obligated to keep copies of the Bill available for inspection and to require you to read it before signing services contracts. To claim when they are not honored: first the plan’s or provider’s internal mechanisms, then the complaint before the Office of the Patient Ombudsman.

• Leaving an emergency because "I have no plan": emergency access does not depend on your ability to pay or your socioeconomic condition.
• Seeking prior authorization before going to an emergency: the law provides that emergency services are given without the insurer’s prior authorization.
• Quietly paying the out-of-network difference in an emergency: you are not responsible above what you would have paid in network.
• Accepting a verbal denial: you have the right to written notice with the grounds and the appeal routes.
• Going straight to external review: the law reserves it for once you have exhausted the plan’s or provider’s internal remedies.
• Not requesting your medical record: the law expressly protects your access to your records, and that record is your evidence.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov