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Your Rights

  • Right to high quality health services.
  • Rights regarding the obtaining and disclosing of information.
  • Rights regarding the selection of plans and providers.
  • Patients right to the continuity of health care services.
  • Right regarding access to emergency services and facilities.
  • Right to participate in the decision-making process regarding your treatment.
  • Right regarding respect and the same treatment.
  • Right to confidentiality of information and medical records.
  • Rights regarding complaints and grievances.

Your Responsibilities:

  • To provide the necessary information about medical plans and the payment of any account. To know the rules of Coordination of Benefits and notify the insurer about any instance or suspicion of fraud against the health plan.
  • To provide the most complete and precise information, including previous diseases, medications, etc. To participate in every decision regarding your medical care. To know the risks and limits of medicine.
  • To know the coverage, options, and benefits and other details of the health plan.
  • To comply with your health plan administrative procedures.
  • To adopt a healthy lifestyle.
  • To notify the physicians of unexpected changes in your condition.
  • To make known that you clearly understand the course of action recommended by the health professional.
  • To provide a copy of your advance directives.
  • To notify the physician if you anticipate problems with the prescribed treatment.
  • To recognize the obligation of the provider to be efficient and equitable when providing services to other patients.
  • To be considerate, so that your particular behavior does not affect other person.
  • To solve any difference through the procedures established by the insurance company.


Law 194 of August 25, 2000, “Letter of Rights and Responsibilities of the Patient”

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.


What is "balance billing" (sometimes called "surprise billing")?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing”. This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

"Surprise billing" is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.


You are protected from balance billing for:
Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Puerto Rico Law No. 134 of September 1, 2020 “Law for the Protection of Patients from Surprise Medical Bills”, as well as local Law No. 194-2000 “The Patient’s Bill of Rights and Responsibilities”, as amended, provides that if you receive emergency services from an out-of-network provider, the provider that offers those services may not billed you in excess of any applicable deductible, copayment, or coinsurance for the services provided, according to your coverage. Any attempt by the provider to bill you in excess must be reported immediately to Triple-S Salud Customer Service Department.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.


When balance billing isn’t allowed, you also have the following protections:
  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in‑network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may file a claim at the Office of the Insurance Commissioner of Puerto Rico.



Edificio World Plaza        Phone: 787-304-8686
268 Av. Muñoz Rivera     Toll Free:1-888-722-8686
San Juan, PR 00918       Fax: 787-273-6082
Piso 9                              www.ocs.pr.gov

Visit https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/no-surprises-act or https://www.cms.gov/nosurprises/Policies-and-Resources/Overview-of-rules-fact-sheets for more information about your rights under federal law.

For information on the payment dispute resolution process, visit: www.cms.gov/nosurprises or call 1-800-985-3059.

Law 134 of September 1, 2020 “Law for the Protection of Patients against Surprise Medical Bills”

787-277-6653 787-474-6326