Clipping of news on Brazilian Culture, Law and Citizenship
08/22/2013
This article was translated by an automatic translation system, and was therefore not reviewed by people.
transparent image
Playing Internet Photo: O Globo
RIO - Fundação Procon-SP announced on Thursday the ranking of the top ten suppliers of health that caused most complaints in the first half of this year. It said the segment ranked sixth among the most demanded, with 6,550 calls between requests for guidance and complaints against the operator or manager of benefits.
Of the ten companies named by Procon-SP, two (and Amil SulAmérica) also appear on the list of carriers that had suspended the sale of plans by the National Health Agency (ANS), but benefited by an injunction of Justice responded to Action Federation National Health Insurance (Fenasaúde).
The CEO of Procon-SP, Paul Arthur Goes, states that the cost is too high for the consumer and return often difficult.
- After 15 years of the regulatory framework for the sector, with the enactment of Law No. 9.656/98, continue the serious problems of access to medical care and application of high levels of adjustment, with particular vulnerability of consumers in group plans, not have adequate protection legislation and the agency itself.
Among the problems faced by consumers who sought the Procon-SP are:
- Coverage Assistance: delay in authorizing procedures, negative total or partial coverage or reimbursement either based on List of Procedures published by the ANS, whether based on questionable contractual exclusion or unilateral interpretations (claim preexisting illness / emergency and emergency)
- Assistance Network: inability to book appointments or examinations; failure to comply with deadlines to meet (consultations, tests, surgeries), changes in the provider network; imposition of restrictions on the right of choice, contractually guaranteed
- Adjustments of age in violation of the status of the elderly; adjustments based on accident rates, retired or dismissed - difficulties in sustaining;
- Cancellation of the plan without notice, errors in the docket, delays in identification cards or slips, and medical guide; excessive penalty for late payments; charges after termination of contract, among others. In this section, continue to highlight the company Qualicorp, which acts as the administrator of benefits in group plans, which now occupy the second place ranking and against whom 176 complaints were computed for the period.
According to Procon-SP, groups Unimed Paulistana, Amil and Greenline were summoned to present a Target Plan Procon-SP, to reduce the number of complaints and increase the resolution of cases ever recorded in the organ. Also according to the agency, the three companies have pledged to achieve solution of 80% of the cases reported in the first call.
Check here for a list of companies published by Procon-SP.
Source: The Globe
Our news are taken in full from our partner sites. For this reason, we can not change the contents of the same even in cases of typos.
This article was translated by an automatic translation system, and was therefore not reviewed by people.