Clipping of news on Brazilian Culture, Law and Citizenship
01/19/2015
This article was translated by an automatic translation system, and was therefore not reviewed by people.
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The negative is a routine in laboratories, according to the president of the Rio Dental Regional Council
Luana Rodrigues, 24, had to undergo preoperative tests before dental surgery. The accountant was surprised to find that your health plan only cover the chest X-ray - necessary to orthognathic surgery (to correct a bone problem on the face) - if the procedure was asked by a doctor. The requirement violates Rule 11, 2007, the National Health Agency (ANS), according to which the plans must authorize admissions and examinations required by dentists.
This negative, however, is a routine in laboratories, according to the president of the Regional Council of Dentistry of Rio de Janeiro (CRO-RJ), Afonso Fernandes Rocha.
- This problem increases every day. It is in bad faith of health plans to postpone the exams.
The dentists Katyuscia Lurentt crossed situation so many times already explains the problem for patients:
- It is an embarrassment. I always give a copy of ANS rule with the request of the examination.
To make the X-ray, Luana asked a gynecologist, family friend, transcribe the application of the procedure, which was then allowed by the plan.
CRO asks companies are notified
The Regional Council of Dentistry of Rio de Janeiro (RJ-CRO) will ask the NSA to pass more information to health care providers and laboratories of tests requested by dentists. According to the trade association, the employees of the companies are unaware of the rule of the regulator, and frequent coverage denials demoralize professionals.
- The patient may find that the dentist is not qualified enough for the job. There is a breach of trust and even more bureaucracy, since he can go to a doctor for examination, which generates the expense of a query to the plan - says Afonso.
When contacted, the NSA stressed that the health provider may not deny authorization to conduct additional tests requested by dentists. The coverage, however, must be provided in the Roll of Procedures and Events Health edited by the regulatory agency and comply with the provisions of consumer contract.
WHAT TO DO
where to complain
If the health plan does not authorize a requested procedure by a dentist, on the grounds that only a doctor could have made the request, the client should contact the carrier and the NSA (0800-7019-656).
intervention
Complaints are handled by the ANS mediation sector, which solves 80% of cases. Last year, the agency received 16,600 health plan customer complaints in Rio.
consequences
The regulatory agency suspended the marketing of health plans with more complaints.
Source: Extra
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This article was translated by an automatic translation system, and was therefore not reviewed by people.