P.R. Laws tit. 24, § 3046
All patients, consumers, and users of medical and hospital health care services in Puerto Rico are entitled to:
(a) Have free, direct and unrestricted access to emergency services and facilities whenever and wherever the need may arise for such services and facilities, regardless of the social or financial status or the ability to pay of said consumer or user, and no health care plan may refuse payment or coverage for emergency medical and hospital health care services to any insured party or beneficiary.
(b) Health care plans shall provide their insured parties and beneficiaries, or in its default, the guardians thereof, with reliable and thorough information concerning the availability, location, and proper use of emergency services and facilities in their respective area, as well as any provisions on the payment of premiums and refund for costs related to said services and the availability of comparable medical care outside said emergency facilities and services.
(c) All health care plans in Puerto Rico shall provide emergency service benefits with no waiting period. The previous authorization of the insurer shall not be required when providing these emergency services; furthermore, these services shall be provided regardless of whether the provider of such emergency services is a participating provider. In the event that a patient is provided services by a provider not contracted by the insurer, the patient shall not be held liable for the payment of services in an amount exceeding the amount applicable if the patient had received such services from a provider contracted by the insurer. The insurer shall compensate the provider offering the services, and the provider shall be under the obligation to accept said compensation, for an amount not to be less than the agreed with the providers contracted by the insurer to offer the very same services. Moreover, under these circumstances, such emergency services shall be provided regardless of the conditions set forth by the corresponding health care plan.
(d) In those cases in which the patient receives health care services after receiving the emergency services or post-stabilization services which would be covered under the health care plan, except for the fact that a nonparticipating provider is involved, the insurer shall compensate the patient for that portion of the costs regarding said services received which differs from the amount the patient would have paid under the plan’s arrangement, provided there are sound medical grounds for which the patient can not be transferred to the care of a participating provider.
(e) The personnel rendering services at an emergency facility shall contact the patient’s primary care physician, should the patient have one, as soon as the circumstances will allow to discuss the follow-up treatment administered to the patient at said facility, the post-stabilization care given to the patient, and the continuation of services, if any, required by the patient’s condition.
History —Aug. 25, 2000, No. 194, § 8; Dec. 16, 2009, No. 176, § 4.