Can a clinic hold you for not paying? The 'carta de garantía' trap and your rights

The key word is «terminantemente»

This is one of the rare cases where a Peruvian regulation leaves no room for nuance. Article 70 of the Regulation of Health Facilities and Medical Support Services (D.S. N.° 013-2006-SA) states, without conditions:

Queda terminantemente prohibido que el establecimiento de salud retenga o pretenda retener a cualquier usuario o cadáver para garantizar el pago de la atención médica prestada, o cualquier otra obligación. Así también, por esta razón, no podrá retenerse la entrega del certificado de nacimiento o defunción.

(“It is utterly forbidden for a health facility to detain, or attempt to detain, any user or body to secure payment for medical care given, or any other obligation. Nor, for that same reason, may the birth or death certificate be withheld.”)

It doesn’t matter whether the debt is real, whether the insurer was slow, or whether the patient signed something earlier. None of that authorizes detention. The rule covers three distinct scenarios under the same prohibition: not letting you leave, not releasing a deceased relative’s body, and not withholding the birth or death certificate — all three, “for that reason” (non-payment), are off limits.

How it usually plays out: the guarantee-letter bottleneck

The mechanics are almost always the same. You or a relative are admitted under insurance coverage — an EPS, a private insurer, or even EsSalud under certain agreements. The clinic asks for a “carta de garantía,” the authorization from your insurer to bill them directly, not you, for the treatment. Until that letter arrives, the clinic treats the case as if coverage weren’t confirmed.

That’s where the pressure appears: you’re told that if you want the patient discharged today, you need to accept “modalidad particular” — paying out of pocket yourself and, in theory, seeking reimbursement from your insurer afterward. This page cannot tell you that accepting that arrangement is always harmless: it depends on your own policy’s reimbursement terms, which we haven’t been able to verify against a general regulation. What we can tell you with certainty is that no rule requires you to sign it, and that using the insurer’s delay as an excuse to withhold discharge falls squarely within Article 70’s prohibition.

Care itself can’t be conditioned either

If the situation began as an emergency, a second rule protects the moment you walk in, not just the moment you try to leave. Article 6 of the Regulation of Law N.° 29414 (D.S. N.° 027-2015-SA) is equally direct:

La IPRESS está obligada a prestar dicha atención, en tanto subsista el estado de grave riesgo para la vida y la salud, no pudiendo condicionar esta atención a la presentación de documento alguno, ni a la suscripción de pagaré, letra de cambio o cualquier otro medio de pago.

This page focuses on what happens after care has already been given — the detention or the pressure to pay before discharge. If what you’re facing is being asked for something before emergency care starts, the page on emergency care rights covers that moment in more detail.

What they CAN do

The law doesn’t say care is free or that the debt disappears. The clinic can bill you, pursue payment through the normal collection channels, and even take civil action for the amount owed if warranted. What it cannot do is use your physical presence, a body, or a document (birth or death certificate) as leverage to collect. Billing is one track; your discharge or the release of a body is another — and the two cannot be mixed.

If this is happening to you right now

The first step is to name the rule out loud and in writing, and ask to speak with someone from medical leadership, not only admissions or the cashier. If that doesn’t resolve things immediately, the formal path is the same one used for any other clinic or insurer failure: a complaint in the facility’s own Libro de Reclamaciones en Salud, and if that isn’t enough, a free denuncia with SUSALUD — no lawyer needed. The page on complaints to SUSALUD explains the exact deadlines for each stage.