Sifredo Acarón, a hematologist-oncologist based in Mayagüez, filed a lawsuit against healthcare insurer Triple-S Salud Inc. and Triple-S Medicare Advantage Inc. for canceling his contract effective June 30.
In the complaint filed in San Juan Superior Court, the physician seeks a temporary and permanent injunction against the provider for its action, which he claims was done without allowing for a contractual appellative process to review the determination.
Acarón, who has been seeing patients for more than 30 years in his office in Mayagüez, said the insurer’s decision will also represent an “incalculable impact” for the Perea Hospital Oncology Department, which he also heads.
In the lawsuit, the defendant claims the insurer’s actions are forcing him to carry out a “quick transition of all of his patients to other providers.”
In April, after more than 20 years belonging to the Triple-S network, the insurer reportedly terminated its contract “without any dialogue, meeting, hearing or explanation.”
“My treatment is personalized and individualized. These are human beings whom I treat as a family. My goal is that the experience they have, in itself difficult, will become more bearable and human,” said Acarón.
“There is also a huge blow to the mental health of these patients, who have placed their trust and their lives in Acarón’s hands and now, without any valid reason, Triple S intervenes in the doctor-patient relationship leaving many without real alternatives and without giving him a chance to be heard,” said Mercedes Montalvo, Acarón’s attorney
“Health care providers are essential because they are those who practice medicine and take care of health, we must be fair and recognize that value, each one has its responsibility,” Montalvo said. “Unfortunately the current system is unbalanced for the provider and for patients, this is not a secret.”
Acarón is one of the few hematologists-oncologists who treats all populations, including Government Health Reform patients. His case “dramatically illustrates the clash of visions in healthcare, in which insurers have absolute control of the management of people’s health,” he said in a statement.
“Situations like this are those faced daily by general practitioners and all specialties, and many prefer to close their practices and leave the island,” Acarón’s representatives said.
With his lawsuit, Acarón seeks to shed light on the processes and decisions that are made behind closed doors and without explanations that continue to undermine the quality and supply of health services on the island.
“This case focuses on Acarón, who is a specialist of relevance and importance in the island, but its impact can be much greater, because this is not even remotely an isolated matter, as it is public knowledge. At some point, doctors and patients have to take action for their rights, without fear and relying on the justice system,” said Montalvo.
In the suit, the defendant asks the Court to issue an order for temporary injunction to freeze a June 28 hearing Triple-S granted to review its decision, giving the physician 30 minutes to present his arguments and evidence against the contract cancellation, two days before it is scheduled to end.