P.R. Laws tit. 6, § 44
Any association organized under this chapter may enter into contracts to furnish hospital and/or medical-surgical services to its subscribers, only with hospitals previously approved by the Department of Health and/or with doctors authorized to engage freely in the practice of their profession in Puerto Rico. All contracts issued by said association to any subscriber shall constitute a direct obligation on the part of the hospital or hospitals and of the doctors which the association may have contracted for such services. Contracts entered into with the subscriber may be individual or may cover the family, including the head of the family, the wife and children under twenty-one (21) years of age, or by groups.
No hospital, doctor or other purveyor of services may charge the subscriber any amount for services rendered and included in the contract, on the grounds that the association has objected to the payment of such service for reasons unknown to the subscriber, or because the association understands that said services rendered were unnecessary or went beyond the acceptable standards of use of the services, or because the services were merely for the custody or care of the patient which is not construed as medical treatment. Any controversy between the association and the purveyors of services shall be resolved as prescribed in §§ 52 and 54 of this title. The subscriber shall be bound to pay the purveyors of services directly for any services not included in the contract, if he has expressly requested that such services be rendered.
Every type of blank form to be used by the association in entering into contracts with the subscribers shall be submitted to the Commissioner of Insurance for his approval.
History —May 9, 1942, No. 152, p. 828, § 4; June 21, 1968, No. 109, p. 219, § 1; June 26, 1977, No. 119, p. 305, § 2.