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NSA says it will continue suspending plans that do not meet consumer

08/22/2013

This article was translated by an automatic translation system, and was therefore not reviewed by people.

 

 



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Agency suspended 212 health plans from 21 carriers, but as was overthrown and fight will end up in court

Rio de Janeiro - The reorganization of the Brazilian health plans, with the departure of companies that are unable to work in the industry, is an ongoing process within the agency. Last year alone, 356 plans 56 operators had suspended the marketing. The ANS evaluates the measure resulted in benefit to the consumer, "since these plans no longer marketed because operators breached deadlines for consultations, exams and surgeries," the advisory organ to the Agency Brazil.
 
Agency estimates that measure resulted in benefits to the consumer
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On Tuesday, the NSA announced the suspension for three months, sales of 212 health plans from 21 carriers. The punishment for noncompliance occurs deadlines and negative coverage. With the announcement, a total of 246 health plans of 26 operators are suspended. On the same day the Federal Court (TRF) of the 2nd Region granted injunction determining that the National Health Agency (ANS) review complaints that should be used to evaluate the suspension of each plan.

The deadlines for service users were established by Resolution 259, December 2011, and compliance by large, medium and small operators is monitored constantly by the NSA. According to the resolution, the maximum period of service for basic consultation in areas such as pediatrics, internal medicine, general surgery, gynecology and obstetrics is seven days and consultations in other specialties, the deadline is 14 business days. Already consultations or sessions with speech therapist, nutritionist, psychologist, occupational therapist and physiotherapist, the maximum term is ten days.

The advisory agency said the number of beneficiaries of health plans are growing at a rapid pace in Brazil. In 2000, they amounted to 31 million people. Today, there are 48 million beneficiaries of health care plans, which shows an increase of 55% in the period. Another 18 million beneficiaries have exclusive dental plans, according to the agency.

With the goal of improving the relationship between consumer and provider, and provider and operator, and provide that the beneficiary health plan receives the assistance he hired, the NSA has adopted a series of measures and setting of deadlines for compliance. An example is the requirement that operators justify the negative coverage to beneficiaries, in writing, within 48 hours. Other measures are the establishment of ombudsmen in the operators and doubling the capacity of service through service Dial ANS (0800 701 9656).

In 2012, the NSA received 75,916 complaints of beneficiaries, especially coverage problems - 57,509 complaints. The press reported that through mediation, the agency was able to resolve 78% of complaints submitted by consumers do not cover, without any need to open court cases.

Failure to comply with the deadlines for service shall be punished with sanctions by ANS operators, ranging from fines to suspension of the marketing plans and establishment of the special technical direction, informed advice. Operators are required to provide beneficiaries all the coverage they contracted and timely. If the consumer is unable to schedule care professionals or health facilities accredited by the plan no later than planned, or has denied coverage under the agreement should make the complaint to the NSA through a service channels. "

Consultations and procedures performed in the office or clinic with dentist have a maximum of seven days. The period is reduced to three working days in the provision of diagnostic clinical laboratory outpatient, but rises to ten days in other diagnostic services and outpatient therapy. For highly complex procedures (CAP) and care in elective inpatients are required up to 21 days.

Primary care in day hospitals rely on up to ten working days for approval. As for emergency care, the deadline set by the NSA for assistance is immediate. For a return visit, the deadline is at the discretion of the professional responsible for the care.

The NSA considers natural reduction in the number of registered companies in the sector in recent years. "In a regulated market, [the reduction] is a natural phenomenon in any segment. It was no different in the sector of health plans, "said a spokesperson for the agency. Since the creation of the agency, for 13 years the number of carriers with beneficiaries decreased from 1,838 to 1,323.

The in situ monitoring of carriers included 98 operators in the regime toward tax, which is a special regime established by ANS companies which have severe abnormalities administrative and economic and financial. Another consequence of the review was that 88 operators had canceled the registration of operation, 113 were engaged in recovery plans for economic and financial problems and 77 are in extrajudicial liquidation. Data refer to June this year.

In May, the agency launched the Practical Guide to Contracts. Facing health service providers and carriers, the publication provides information on the regulations in force, including mandatory clauses in contracts that provide for items such adjustment, setting values of the contracted services, billing and payment deadlines. The goal, said the NSA is to prevent conflicts.

In the service to the citizen, the main recommendation that the NSA is for people who wish to purchase a health plan is that hiring is designed according to the needs of consumers and their families. Ie, that one does not get carried away by an impulse decision, momentary.
Citizens can access information about companies that operate in the market and its position close to the regulator on the agency website - www.ans.gov.br.


Source: The Day - Online

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This article was translated by an automatic translation system, and was therefore not reviewed by people.

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