Clipping of news on Brazilian Culture, Law and Citizenship
07/05/2013
This article was translated by an automatic translation system, and was therefore not reviewed by people.
Rule requiring submission of justification comes into force on Tuesday.
Order of explanation should be done by the beneficiary.
From this Tuesday (7), health plans that deny permission to any procedure requested by the doctor or dentist will have to submit written justification to the beneficiary who requests it.
Upon the request of the insured, the carrier will have a period of 48 hours to provide the rationale for the negative, by mail or electronic means.
"The operator of private health care should inform the beneficiary in detail in clear language and appropriate, and within 48 (forty eight) hours counted from the negative, the reason for the refusal of authorization of the procedure, indicating the clause contractual or legal provision to justify it, "says the ANS standard, published in the Official Gazette on March 6.
If the company fails to submit the written justifications, after the request of the beneficiary is subject to a fine of £ 30,000.
Currently, according to the agency, there are 47.9 million beneficiaries with health care plans and 18.6 million beneficiaries with dental plans only.
Suspensions
Starting in July, claims against health plans deny coverage may result in fines and even suspensions plans. Negative coverage related to list of procedures, grace period and service network will become part of the quarterly monitoring reports that the NSA does since December 2011.
The plans that appear in these reports can be fined up to $ 100 thousand, be suspended in case of recidivism and lead to the removal of their leaders.
Source: G1 - News
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This article was translated by an automatic translation system, and was therefore not reviewed by people.