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Private hospitals forced to return tens of thousands of euros to users

Several private hospitals were fined by the Health Regulatory Entity (ERS) and forced to return tens of thousands of euros improperly charged to users for not previously informing users of the total costs.

According to the resolutions issued in the 4th quarter of last year, released this Tuesday, ERS concluded that the Hospital da Luz, SA and the Hospital CUF Descobertas, both in Lisbon, as well as the Hospital Privado da Boa Nova (Matosinhos) violated the right to prior information to users of the total amounts to be charged for the medical care provided, conditioning in some cases the freedom of choice.

With regard to Hospital da Luz SA, the ERS refers to dozens of cases that occurred in the Hospital da Luz — Lisboa and Hospital da Luz — Torres de Lisboa units.

He says that the performance of the supplier “did not prove to be adequate and effective” in order to safeguard the rights to information of all complaining users, to “total and unconditional download” in some cases and to freedom of choice in others, thus having initiated an administrative infraction file.

Of 13 cases analysed, ERS orders the provider to review the billing and return the amounts collected to the users, which in the aforementioned cases exceed 1,500 euros.

The regulator considers that both units of Hospital da Luz SA also violated the duty to keep their registration data updated, that is, information on the agreements and conventions they have.

It warns that health service providers must refrain from presenting estimates or incomplete budgets for treatment episodes and stresses that, when it seems impossible to estimate all the acts, tests, consumables or medications that may be used, “users must be clearly informed of this impossibility of estimating and warning of its relevance in the total cost”.

In the case of agreements with the SNS, with the ADSE or other public or private health subsystems or with health insurance, the regulator states that the providers must take “special care in transmitting information on the conditions of access of users to the medical care they provide”.

It must be guaranteed that, prior to the provision of health care, users are fully informed about the existence of conventions or agreements and their applicability in the specific case, especially if the proposed acts are covered by the respective coverage”, writes the regulator.

Regarding the CUF Descobertas Hospital, ERS refers to the case of a user who was presented with a budget for a surgery worth 7,000 euros and subsequently received a payment invoice of about 17,000 euros.

In this case, ERS says that the provider “violated the rights and legitimate interests of users“, beginning with the obligations of “providing truthful, timely and transparent information” prior to the provision of health care.

In a more in-depth investigation, the regulator claims to have been aware of 12 more identical complaints (billing problems), having ordered the review of the invoices in question and the return of improperly collected amounts, which in the aforementioned cases exceeds 21,000 euros.

Orders the CUF Descobertas Hospital to review and update the current procedures and make the necessary corrections and, given that some reported cases indicate a violation of the freedom of choice of the users, the ERS determined the opening of the respective administrative infraction procedure.

Finally, regarding the Boa Nova Private Hospital, it also says that it was found that the provider’s actions “put into question the legitimate rights and interests of users” in terms of the delivery of “rigorous, timely and transparent” information, prior to the provision of health services, and orders the review and updating of the procedures, making the necessary corrections and the return of amounts improperly collected.

Once at least one case has been detected that indicates a violation of the user’s freedom of choiceIt was also decided to open an administrative infringement procedure.

Users must know, with the greatest accuracy and approximation possible, the total cost of the proposed treatment and intervention, in order to be able to confirm if they are in a position to bear such costs, by themselves or through some subsystem or insurance contract. that it possesses”, stresses the regulator.

Source: Observadora

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