Clipping of news on Brazilian Culture, Law and Citizenship
03/05/2013
This article was translated by an automatic translation system, and was therefore not reviewed by people.
New standard comes into force 60 days after publication
BRASILIA. - The health insurance companies that deny permission to its members to carry out medical procedures shall make written notice whenever the customer requests. The information should be in plain language, indicating the contractual or legal provision to justify the denial.
The Health Minister Alexandre Padilha, which is considered essential that the user can know why the call was not right. He noted that in emergency situations and emergency coverage must be shown.
- Besides being a right which the user has to information, to contest with the ANS and Justice (standard) improves the effort that the NSA has been doing in terms of pedagogical measures to improve health care delivery to the user health plan - said.
The new standard, released on Tuesday by the National Health Agency (ANS), shall enter into force 60 days after its publication. The written notice must be sent within 48 hours to the customer by email or by post. If disobeying the measure, operators will be punished with a fine of R$ 30 000.
- The standard reinforces that coverage can not be denied in cases of urgent and emergency care - said Andrew Long, CEO of ANS.
The measure will be published by the ANS Normative Resolution 319 and also reflects the concern of the National Council of Justice (CNJ). In practice, the written justifications of operators can be attached to any proceedings in court. Besides the fine for not informing the written reasons for the negative coverage provided by law, operators are subject to two other fines. The fine for improper denial of coverage is $ 80,000 and, in cases of emergency rooms, R$ 100 thousand.
- It is important that in this case, the beneficiary take care protocol. If the information does not arrive within 48 hours, (it is important) and then report it to the agency as we fine the operator for R$ 30 000. To this can be added the negative coverage of their own. Then the fine ranges from R$ 80,000 to R$ 100,000 - said the CEO of ANS.
Today, 62 million Brazilians have coverage for medical or dental plans in the country. Last year, the NSA has received 75,916 complaints from consumers of health plans. Of this total, 75.7% refer to negative coverage.
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Source: The Globe - Online
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This article was translated by an automatic translation system, and was therefore not reviewed by people.