P.R. Laws tit. 26, § 9287
All contracts with providers for the provision of limited health services to subscribers shall contain the following terms and conditions:
(a) In the event the limited health service organization fails to pay a provider for rendering services to a subscriber, including insolvency or breach of contract or any other reason, the subscribers shall not be liable to the contracted provider for any sums owed.
(b) No provider, agent, trustee, or assignee thereof may initiate an action at law or attempt to collect from the subscriber sums owed to the provider by the limited health service organization.
(c) These provisions do not prohibit collection of charges not covered by the limited health service organization to the subscriber such as copayments, deductibles, or coinsurance, provided that it has been agreed upon in the contract or policy between the limited health service organization and the subscriber.
(d) The provisions of this section shall remain in effect regardless of the termination of a contract between the limited health service organization and the subscriber and the reasons for such termination.
(e) Termination of the contract between the limited health service organization and the provider shall not exempt the provider from completing procedures in progress on subscribers then receiving treatment for a specific condition for a period not to exceed thirty (30) days, subject to the same copayment or other applicable charge in effect upon the effective date of termination of the contract. This period of time shall only apply in those cases in which a transition period for the continuation of services for subscribers as a result of the termination of a contract between the limited health service organization and the provider has not been provided under federal or Commonwealth law.
History —Aug. 29, 2011, No. 194, added as § 16.170 on Aug. 23, 2012, No. 203, § 2, eff. 90 days after Aug. 23, 2012.