On February 3, 2014, Puerto Rico’s Legislature approved Bill Number 5 in order to amend the Health Insurance Code. The amendment states that only the doctor is the one who can decide over the hospitalization of the patient. Therefore, the determination regarding the hospitalization of a patient does not falls on the heath care insurer or the hospitalists, but it is only and exclusively a determination taken by the doctor who is treating that patient.
According to the article published by NotiCel on February 10, 2014, the billed was promulgated due to information made public during 2013, in which hospitalists, following health care insurers’ instructions, allegedly were revoking doctor’s orders to hospitalized patients. The bill was promulgated by Senator Ángel “Chayanne” Martínez, while Representative Lydia Méndez promulgated a substitute bill, which expanded the bill’s reach.
As part of the amendments, the concept of “medical necessity” is defined as a criterion that must be considered in order to prevent hospitalizations that are not justified by the patient’s condition or that benefit economically the heath care insurers.
The president of the Committee on Banking, Insurance and Telecommunications, Senator Ramón Luis Nieves, expressed that “with this bill, we assure that the treatment that the patient really needs is provided, and not the one the heath care insurers are willing to pay.”
We believe that the amendments to the Health Insurance Code, through Bill Number 5, are necessary. Health care insurers are not doctors, therefore they are not qualified to decide which patient needs or does not need to be hospitalized. Only the doctor who is treating the patient knows if his or her conditions merit a hospitalization.
We hope that this amendment to the Health Insurance Code, benefits patients and that their health are no longer manipulated by health care insurers actions in order to gain economic benefits.