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KMID : 1234820120130020045
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Korean Society of Law and Medicine
2012 Volume.13 No. 2 p.45 ~ p.72
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An Examination of the Exactitude of Legal Application behind the National Health Insurance Corporation’s Practice of “Collection and Disbursement” of Paid Medical Expenses (With an Emphasis on Arbitrary Denial of Coverage)
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Song Myung-Ho
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Abstract
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The National Health Insurance Corporation has been retrieving from health care providers the payments made to them by insured patients as a result of the health care providers’ arbitrary denial of coverage under the National Health Insurance, and has been disbursing such retrieved monies back to the patients, pursuant to Article 57, Sections 1 and 4 of the National Health Insurance Act. However, such practice is an application of the law that lacks legal exactitude. Another problem with such practice is that there is no legal provision under any laws or notices that expressly prohibits arbitrary denial of coverage. A legislative solution, therefore, is called for to address these issues.
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KEYWORD
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Arbitrary Denial of Coverage, Collection oh Unjust Enrichment, unlawful means, improper means, Criteria for medical care benefits, compulsory provisions
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