T-563/19
Provision and payment for specialized therapy not covered by the public health care plan. Children with alleged physical, sensory, or cognitive disabilities
William Ricardo Utrera Reyes & others v. Famisar E.P.S. & others
Date: 11/20/2019
Judge-Rapporteur: Luis Guillermo Guerrero Pérez
Dissent: Alejandro Linares Cantillo (partial)
Facts. The Court decides on 37 joined legal actions instituted to request the provision and payment of health care services to minors. Thirty-six of the actions involve minors diagnosed with different physical, sensory and cognitive disabilities, who seek to access specialized treatments on behalf of the public health system, when the referring physician or the institution providing the health services do not belong to the network of their public health plan. The other action refers to the medical institution providing medical services to 500 children which requires the Governorate of Cordoba to pay for such services.
Issue: Should the public health system provide and pay for health services no included in the health plan or administered by health operators outside of its network?
Ruling and reasoning. No, if there are reasonable doubts about the accuracy of the information provided by the petitioners that may void their right to the health service, or that the selected path to get the services is not the regular one. The Chamber ordered to notify the competent authorities of the alleged commission of irregularities in the procedure of accessing the public health care system, that may have been committed by the interveners.
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