Clipping of news on Brazilian Culture, Law and Citizenship
08/21/2013
This article was translated by an automatic translation system, and was therefore not reviewed by people.
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Health Minister Alexandre Padilha, director and president of ANS, Andrew Long (left). Announce results of the latest round of monitoring operators' health plans Photo: André Coelho / O Globo
RIO AND BRASILIA - RIO AND BRASILIA The National Health Agency (ANS) yesterday announced the suspension of 212 health plans from 21 carriers, for a minimum period of three months, do not pass the assessment that takes into account criteria such as within attention and negative coverage. They have in their wallets 4.7 million beneficiaries, or 9.7% of the total number of people served throughout Brazil. But in the late afternoon, a decision of the Federal Court (TRF) of the 2nd Region (Rio and Espirito Santo) prevented the punishment of ANS the three companies on the list linked to the National Health Federation (Fenasaúde): Amil, SulAmérica and Amico , plans to add 135 suspended.
SEE COMPLETE LIST OF OPERATORS WITH PLANS 21 SUSPENDED
The NSA had previously punished other companies, and with the decision yesterday, a total of 246 agreements 26 operators could not be marketed. The measure would be valid until operators suited to the deadlines set by the regulatory agency. Each monitoring cycle lasts three months.
In the decision of the Federal Court, Judge Aluisio Mendes resource Fenasaúde partially met and determined that before punishing the regulatory review evaluation criteria and check the score negative health carriers for claims that have not exhausted the possibilities of defense companies. This score is a criterion to prevent the marketing of products. The federation says it has resorted to court after identifying "mistakes in the process of monitoring the deadlines of care for beneficiaries."
The decision of the NSA yesterday was the first suspension of health plans with a new methodology. Before, it was considered only the terms of service. The previous monitoring, done in April, already had the new criteria, the negative coverage, including the list of procedures offered, grace period, service network, and reimbursement mechanisms for authorization procedures. At the time, there was no suspension. As April ended the first monitoring cycle with the new methodology, it was not until the last cycle, released yesterday.
The decision was announced the participation of the new director of the NSA Elano Figueiredo, whose appointment is under review by the Ethics Committee of the Presidency. Report published by GLOBE two weeks ago showed that the lawyer failed in the curriculum that was legal director of the company Hapvida and advocated for Unimed.
Amil, Amico, SulAmérica, which benefited from the decision of Justice, are precisely the companies with the highest number of suspended plans, respectively, 91, 31 and 13. The action of Fenasaúde was presented last August 12, but the 21 th Court of Justice of Rio denied the injunction intended to nullify the effects of the resolution of ANS with punishment rules for operators. The lawyer for the operators, Sergio Bermudez, resorted to TRF.
- The goal is to prevent ANS suspend the marketing plans, as profoundly affects businesses, especially Amil and SulAmérica, based on a preliminary investigation. With the approval of our interlocutory appeal today's decision of the NSA loses the effect. They sang the victory ahead of time, published a list of products based on the refusal of the injunction in the first instance and the appeal lacked - Bermudez said.
The regulatory agency, via note, said that has not been formally notified of the judgment and conviction that has highlighted the quality of the process that examines complaints from consumers. "The ANS respect judicial decisions, but maintains the position that the process of monitoring the warranty service is essential in regulating the industry and aims to protect consumers.
The NSA explained that the monitoring of plans is done through computerized systems. After this phase, the entire process is performed by the technical agency and the final list is submitted to the executive board, which consists of the five directors of the Agency, including, Figueiredo. "In this case, the list presented was unanimously approved," said the NSA.
Selma Amaral, Director of Customer Procon-SP, was surprised by the ruling, because it assesses that the NSA has been quite transparent in the criteria used for suspension and support shown for this procedure.
Since 2011, there have been six monitoring cycles. According to the CEO of ANS, Andrew Long, they resulted in the temporary suspension of 618 health plans from 73 carriers, protecting consumers 7.9 million or 16.3% of all beneficiaries in the country. Asked if, in general, the government was satisfied with the health plans, since the majority was not reached by the suspension, the Health Minister, Alexandre Padilha, said:
- We will only consider that are working well, when we have zero complaints.
From March 19 to June 18, during the last monitoring cycle, which had the results released yesterday, 17,417 complaints were received, relating to 553 operators. Most complaints, according to the ANS, can be resolved through mediation agency.
The ministry also announced that ANS and 125 plans six operators, which had been suspended previously, are being reactivated. 52 of them are from Unimed Paulistana, who is leaving the list of companies with services suspended. The rest is for operators who, despite improvements made, continue with some plans on hold.
- In addition to the fines, the main punishment that monitoring cycle is the suspension of the sale. We are very aware and convinced that it is the punishment that has the fastest result for the consumer, because it moves immediately on the profitability of operators. Does not depend on administrative procedure or procedure in court, they can often take - Padilha said.
According to the Ministry of Health, there are 48.6 million beneficiaries of health care plans and other 18.6 million dental.
Source: The Globe - Online
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This article was translated by an automatic translation system, and was therefore not reviewed by people.