Para crear la “Ley Contra Represalias Contractuales de Aseguradoras a Proveedores de Servicios de Salud”, a los fines de prohibir la cancelación, no renovación o modificaciones unilaterales en los contratos de profesionales e instituciones de servicios de salud por parte de las aseguradoras de planes médicos en represalia por haber presentado una solicitud de revisión de tarifa, reclamación por pago oportuno de las reclamaciones, queja, demanda, querella o denuncia u ofrezca o intente ofrecer testimonio, expresión o información ante un foro legislativo, administrativo o judicial en Puerto Rico, así como el testimonio, expresión o información que ofrezca o intente ofrecer, en los procedimientos internos establecidos en la aseguradora o foro administrativo, o ante cualquier entidad en posición de autoridad para adjudicar prácticas ilegales de las aseguradoras, reclamación de cobro de deuda y cualquier otro derecho reconocido por leyes especiales; y para otros fines relacionados.

2025-2028 Session

Puerto Rico bill prohibits health insurers from retaliating against healthcare providers who file complaints, seek fair rates, or provide testimony to authorities.

Referido a Comisión(es)

Legislative bill overview

Bill PC 923 would prohibit health insurance companies from canceling, refusing to renew, or unilaterally modifying contracts with healthcare providers as retaliation for filing rate reviews, payment complaints, formal complaints, legal claims, or providing testimony to legislative, administrative, or judicial bodies in Puerto Rico. The law would also protect providers who report illegal insurance practices or participate in internal insurance company proceedings.

Why is this important

Healthcare providers often depend on insurance contracts for their business viability, creating an imbalance of power where insurers can use contract termination as a weapon to suppress complaints about unfair practices. This bill aims to protect medical professionals and institutions from economic retaliation when they advocate for fair treatment, potentially leading to better compliance with payment obligations and fair pricing. Without such protections, providers may remain silent about abusive practices to preserve their contracts, harming both their livelihoods and patient care quality.

Potential points of contention

Defining retaliation: Determining whether a contract non-renewal constitutes illegal retaliation versus legitimate business decision could create litigation disputes and require clear regulatory guidance

Insurance industry costs: Insurers may argue the law limits their ability to manage networks and terminate underperforming contracts, potentially increasing premiums for consumers

Implementation burden: Requires establishing enforcement mechanisms and administrative procedures to investigate complaints, creating new bureaucratic requirements and costs for government agencies