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MPF: plans should suspend charging for medical availability for delivery

03/27/2015

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



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According to the recommendation issued by the Federal Public Ministry (MPF), health insurance providers must suspend collection of medical fees of the beneficiaries when asked certain doctor is available for the completion of delivery, normal or cesarean section, the call rate availability. The collection is prohibited by Federal Law 9.656 / 98, which provides that private insurance plans and health care must fully cover the cost of fees that occur during hospitalization, including obstetrics. The recommendation was made by the Working Group Health Plans of the 3rd Chamber of Coordination and Review (Consumer and Economic Order) of the MPF to the Brazilian Association of Medical Group (Abremge), the National Federation of Supplementary Health (FenaSaúde), the National Confederation of Medical Cooperatives (Unimed) and the National Union of Self-Management of Health Institutions (United).

According to the MPF, these four organizations will have to notify the medical providers about the illegality of the collection, in addition to monitoring the scales of night shifts of medical and laboratory service providers, for teams to ensure assistance to pregnant women, with prescription Medical normal delivery.

The lawyer specialized in consumer protection in health matters, Melissa Areal Pires, explains that the controversy exists because doctors believe that this rate is cool as they get, the plans, the consultations and the delivery, but not to be available day and night for the procedure.

They argue, explains the lawyer, the right of the patient to give birth covered by the plan is guaranteed because all maternity provides necessary staff accredited to carry out the delivery, but if the mother wants to be accompanied by a specific professional, these fees should be paid separately for it.

Melissa recalls that the National Health Agency (ANS) has positioned itself against the charges, saying the coverage already includes the fees for the completion of delivery. Consumer protection entities also are against the fee.

- I share that assessment, in that it sets contractual limitation and unreasonable disadvantage to the pregnant woman, who paid for the full coverage obstetrics, including medical fees. If the doctor is certified, if the pregnant woman has contracted obstetrics coverage, there is no reason to pay extra fees to the professional rather should be available to perform the procedure at any time, given the nature of the procedure, which, in fact , may start at any time. If to not be available, should not be accredited to the plan in obstetrics mode - advocates lawyer.

Sought for comment recommendation of the MPF, FenaSaúde and Unimed Brazil recognized that the charge is illegal and informed guide attached to comply with the law. "The beneficiary has no obligation to pay any extra value to the doctor," said the FenaSaúde through note.
Have Abramge and United argue that the fee charged by obstetricians to monitor pregnant women is not included in Rol Procedures in Health ANS, which determines mandatory coverage, and therefore there is no coverage by the operators.



Source: The Globe

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

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