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

Several private hospitals have been fined by the Health Regulatory Authority (ERS) and forced to return tens of thousands of euros erroneously charged to users because users were not previously informed of the total costs.

In accordance with the decisions made in the 4th quarter of last year, published today, ERS has concluded that Hospital da Luz, SA and Hospital CUF Descobertas, both in Lisbon, as well as Hospital Privado da Boa Nova (Matosinhos) have violated the right to preliminary information to users of the total amount charged for the medical care provided, which in some cases leads to freedom of choice.

With regard to the hospital da Luz SA, ERS refers to dozens of cases that occurred in the departments of the hospital da Luz – Lisbon and the hospital da Luz – Torres de Lisbon.

It states that the provider’s actions “did not prove appropriate and effective” in terms of protecting the rights to information of all users who filed complaints, to “full and unconditional release” in some cases and freedom of choice in others, therefore opened a misdemeanor proceeding .

Of the 13 cases analyzed, ERS is ordering the provider to revise the billing and refund the users the deducted amounts, which in the cases mentioned exceed 1,500 euros.

The regulator considers that both divisions of Hospital da Luz SA also violated the obligation to keep their registration data up to date, namely information about the agreements and conventions they have concluded.

Warns that health care providers should refrain from providing incomplete estimates or budgets for treatment episodes, and stresses that whenever it seems impossible to estimate all activities, tests, supplies, or medications that may be used, “users should be clearly informed about the impossibility of valuation and warned about its relevance to 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 cites that providers must exercise “special care in communicating information about the conditions for users to access the health care they provide. “.

“It should be ensured that users are fully informed of the existence of conventions or agreements and their applicability in a particular case before providing medical care, especially if the proposed actions are covered by the relevant coverage,” the regulator writes. .

With regard to CUF Descobertas Hospital, ERS refers to the case of a user who was presented with an operation budget of €7,000 and subsequently received an invoice for payment of around €17,000.

In this case, ERS says the provider “challenged the rights and legitimate interests of users,” from obligations to “provide accurate, timely, and transparent information” to providing medical care.

In the course of a deeper investigation, the regulator claims that it became aware of 12 more identical complaints (billing problems), ordering the examination of the invoices in question and the return of unreasonably charged amounts, which in the cases mentioned exceed 21,000 euros. .

Orders CUF Descobertas Hospital to review and update existing procedures and make necessary corrections, and as some of the reported cases indicate a violation of users’ freedom of choice, ERS has determined that appropriate administrative proceedings will be opened.

Finally, with regard to Boa Nova Private Hospital, he also says that there was evidence that the provider’s activities “cast doubt on the rights and legitimate interests of users” in providing “thorough, timely and transparent” information prior to the provision of medical care, as well as orders to review and update the procedures, make the necessary corrections and return the unreasonably recovered amounts.

Since at least one case was identified, indicating a violation of the user’s freedom of choice, it was also decided to open proceedings on an administrative offense.

“Users should know as accurately and as closely as possible the total cost of the treatment and intervention they are offered in order to be able to confirm whether they are able to cover such costs themselves or through any subsystem or insurance contract. you own,” the regulator emphasizes.