2024-04-18 19:22:07
A pensioner had posted an injunction.
The Federal Justice of Tucuman gave rise to an injunction, filed by a pensioner against the increases in fees she received from her medical firm prepaidand ordered that they shall remain without effect and that the increase given in the latest publication by the enforcement authority shall be applied to the value of the quota with a ceiling of 8.51% from January and for each subsequent monthly period until a final order is made. .
According to the decision, the woman, 69 years old and undergoing cancer treatment, stated that her private medical company sought an unreasonable increase in the fees for her services after the publication of DNU No. 70/23. He reported that in December 2023 he paid the sum of $116,669.87 and that in January 2024 the bill rose to $163,921.16, which meant an increase of 40.49% from one month to the next.
That February 2024 invoice increased the value again by 28.49%, so the fee was $210,638.69, a total increase of 80.54% in two months. And he stated that in the face of such a situation on the dates 02.08.24 and 21.02.24 he ordered the defendant to adjust the value on the invoice because he considered the increase to be illegal or illegitimate.
After this, the federal judge Jose Manuel Diaz Velez broke down the case. “Performing an analysis of art. 267.
In this way, by erasing part of the art. 17 of Law 26.682, the functions of the Superintendency of Health Services of the Nation are abolished, which in its role as an enforcement authority monitored the reasonableness of the plans’ fees, and was likewise the one who authorized their increases “when “it is based on variations in the cost structure and reasonable actuarial calculations of risk,” he said.
According to the judge, in the notes that the company has sent to the plaintiff, “it appears that the defendant limits himself to giving generalized statements about the situation in the country, but a concrete justification for the percentage increases that have been applied to the quotas is not forthcoming. clearly monthly.”
“I consider the right invoked by the plaintiff to be plausible (…) even more so if we take into account the double vulnerability situation that the plaintiff has due to his status as a pensioner and an oncology patient,” he added. .
Díaz Vélez then stated that “I consider the delay jeopardy claim to be proven in the records since it appears from the case records that the claimant is receiving a pension benefit of $165,721.61 and the increases would be greater than what was received. Therefore, the risk of lack of medical coverage due to impossibility or non-payment jeopardize the continuity of their oncology treatment and put their health and lives at risk.”
And then he invoked the arguments presented by Federal Judge No. 1 in Salta in a similar case where he considers “it is necessary to ensure the conditions of access to the health service entered into by the ampararista while the underlying problem is defined, i.e. reasonable to establish an indicative adjustment of the monthly fee which provides a certain predictability for the parties and which does not imply – in the current economic context of high inflation – an impact on the property rights of the defendant company and the conditions for the sustainability of the services it provides.
For all this, as already explained, Díaz Vélez ordered “that the increases applied to the plaintiff’s monthly membership dues as a consequence of the decree of
Necessity and urgency 70/2023 (PEN) and, applies to the value of the monthly fee the increase given in the latest publication by the application authority with a ceiling of 8.51% from January and for each subsequent monthly period until a final ruling is made.
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