Clipping of news on Brazilian Culture, Law and Citizenship
10.21.2015
This article was translated by an automatic translation system, and was therefore not reviewed by people.
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If it is not an emergency, patients can no longer resort to the central to be served
São Paulo - The National Center Unimed scored a victory in court and was free from the obligation to help customers Paulistana Unimed if they can not be met within 24 hours, as had been determined on 17 September for a judge of.
In new decision, Judge Maria Rita Dias Rebello Pinho, the 18th Civil Court of Sao Paulo, predicted that Central only has to take the cases of emergency care which are not met by Paulistana.
Thus, the Paulistana customer who find it difficult to accomplish an exam or routine visit, for example, can no longer resort to the Center to be served. Maria Rita also determined that Unimed of Brazil share the responsibility of helping customers Paulistana with Central.
Sought, Unimed of Brazil - confederation of cooperatives of Unimed system - claims not to have accredited or accredited medical network to make calls. The Paulistana not commented.
Relief amid crisis
The obligation to help customers of Paulistana was a request from the Brazilian Institute of Consumer Defense (Idec) to circumvent the crisis in care caused by determining whether the second operator divest itself of its portfolio of beneficiaries, released on September 2 by the National Health Agency (ANS).
As iG showed, shortly after the decision of the agency, customers Paulistana, which were already experiencing difficulties in meeting due to financial difficulties of the carrier, had tests and appointments canceled for doctors and accredited laboratories - a practice forbidden by law.
National Unimed will have to bail out only emergency cases Paulistana
Photo: Luis Philipe de Souza / IG
The ruling by Judge Maria Rita, however, was having an impact "giant" on the accounts of Unimed National Center, and put at risk the customer service of this operator, says the legal overseer Jeber Juabre Junior. In less than a month, the Central authorized 6,583 procedures to 3,782 customers Paulistana.
"The impact has been extremely large. It should be considered that we have to face the cost without having had the recipe [the fees that were paid to Paulistana]," says Juabre Junior. "The Paulistana spent a month R $ 209 million [to service the portfolio of 744,000 customers]. The net profit of the Central in 2014 was R $ 42 million. How do I forward at a monthly cost of R $ 209 million [ without receiving tuition]? "he asked.
The superintendent said he knew estimate what will be the impact of the decision on the number of procedures Paulistana that Central has to take, nor on the costs of such visits. Idec said it would assess whether attempts to reverse the decision.
Portability
Customers Paulistana that have individual or collective plans of up to 30 lives have until the end of the month to migrate to other operators in the Unimed system without losing the grace period - minimum period of stay in a plan to be able to use the services offered by it .
Customers of the Greater São Paulo - except Guarulhos, Mauá, ABC, Ribeirão Pires, Rio Grande da Serra and Vargem Grande Paulista - may migrate to Central, Unimed Seguros or Unimed Fesp, and have at their disposal at least four options ( see table below).
By legal Superintendent of Central, after complaints that they would have to pay more for less service networks, the operator included six other hospitals in the plans offered to customers of Paulistana. "He [the client] has a smaller but more effective network. The network that he had in Paulistana she was not given," argues Juabre Junior.
The remaining customers should seek Unimed of Brazil, which will forward them to local cooperatives. In all cases, one year after accession, if the NSA permission, the new cooperatives can readjust plans by up to 20%.
Source: The Day
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This article was translated by an automatic translation system, and was therefore not reviewed by people.