According to the resolutions issued in the 4th quarter of last year, ERS concluded that Hospital da Luz, S.A. and Hospital CUF Descobertas, both in Lisbon, as well as the Hospital Privado da Boa Nova (Matosinhos) violated the right to prior information of the total amounts to be charged for the health care provided, conditioning in some cases the freedom of choice of users.
With regard to Hospital da Luz S.A., ERS refers to dozens of cases that occurred in the Hospital da Luz – Lisbon and Hospital da Luz – Torres de Lisboa units.
It says that the provider's action "has not proved to be adequate and effective" in order to safeguard the rights to information of all users who complained, to "full and unconditional discharge" in some cases and to freedom of choice, having therefore opened administrative offence proceedings.
Of the 13 cases analysed, ERS orders the provider to review the billing and return to users the amounts charged, which in the cases referred to exceed 1,500 euros.
The regulator considers that both units of Hospital da Luz S.A. have also violated the duty to keep their registration data updated, namely information on agreements and conventions of which they are holders.
It warns that healthcare providers should refrain from presenting estimates or budgets of incomplete treatment episodes and stresses that, whenever it does not seem possible to estimate the totality of acts, tests, consumables or drugs that may be used, "clients should be clearly informed of this impossibility of estimation and warned of its relevance in the total cost".
In case of agreements with the NHS, ADSE or other public or private health subsystems or with health insurance, the regulator states that providers must take "special care in transmitting information on the conditions of access of users to health care provided by them".
"It should be taken care that, at a time 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 in the respective coverages," the regulator writes.
As for the CUF Descobertas Hospital, ERS refers to the case of a user who was presented with a budget for surgery in the amount of 7,000 euros and, subsequently, received for payment an invoice that was around 17,000 euros.
In this case, the ERS says that the provider "has questioned the rights and legitimate interests of users", first of all at the level of the obligations to "provide rigorous, timely and transparent information" at a time prior to the provision of health care.
In a further investigation, the regulator says it has become aware of 12 more identical complaints (billing problems), having ordered the verification of the invoices in question and the return of the amounts unduly charged, which in the cases pointed out exceeds 21,000 euros.
They asked that the Hospital CUF Descobertas reviews and updates the current procedures and make the necessary corrections and since some reported cases indicate the violation of the freedom of choice of users, the ERS determined the opening of the respective administrative offense process.
Finally, regarding the Boa Nova Private Hospital, it also says that evidence has emerged that the provider's action "has called into question the rights and legitimate interests of users" regarding the provision of "rigorous, timely and transparent" information, at a time prior to the provision of health care, and orders the review and updating of procedures, making the necessary corrections and returning the amounts unduly charged.
Since at least one case was detected that indicates violation of the user's freedom of choice, it was also determined to open administrative proceedings.
"Users should know, as accurately and closely as possible, the total cost of the treatment and the intervention that is proposed to them, in order to be able to confirm whether they have the capacity to bear such costs, by themselves or through any subsystem or insurance contract of which they are holders," the regulator stresses.
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