Clipping of news on Brazilian Culture, Law and Citizenship
01.15.2016
This article was translated by an automatic translation system, and was therefore not reviewed by people.
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The National Health Agency (ANS) has created new rules in order to improve the care provided by managed care plans to beneficiaries in requests procedures and healthcare coverage services. The measures defined by the Normative Resolution (RN) No 395, shall enter into force on the day 15/05 and establish deadlines for providing information to the consumer, disciplining and qualifying service, and oblige operators to provide face and telephone contact channels .
The RN says that when demanded, operators must provide immediately to its beneficiaries information and guidance on the procedure or assistance requested service, clarifying whether there is cover provided for in Roll of Procedures and Events Health ANS or contract. It also establishes the unit of deployment for contact hours working during business hours on weekdays in the capitals of the states or regions of higher performance plans, except for the small operators, exclusive dental care, philanthropic and self-management.
The large companies will also have to offer telephone customer service 24 hours, seven days a week, and the medium and small, the only dental and philanthropic should have telephone channel to office hours on weekdays. To ensure the care of patients with urgency and emergency, all operators should provide phone service 24 hours, every day of the week.
The resolution also requires that whenever there is a procedure for making request and / or healthcare coverage service by the beneficiary, regardless of the channel through which be realized or what their purpose, must be supplied protocol number at the beginning of the service or as soon as identify the clerk that it was demand involving healthcare coverage.
"The operator is the first consumer service channel and she needs to take a quick and satisfactory answer to the beneficiary," says the director of Supervision of the ANS, Simone Freire. "With these rules, we want to strengthen and regulate the response to requests procedures and healthcare coverage services, encouraging health plans qualify contact with beneficiaries, improving, overall, the service," he adds. According to the director, transparency, clarity and information security, promptness and courtesy and continuous improvement are the guidelines that should guide the care operators to beneficiaries.
TIME RESPONSE - In cases where it is not possible to provide immediate response to the request procedure or healthcare coverage service presented, operators will have a term of up to five working days to respond directly to the beneficiaries. If the answer presented deny performing procedures or services requested, should be informed in detail the subject and the legal provision that justifies it. In requests for highly complex procedures (APAC) or elective inpatient care in regime, the deadline for response is up to ten working days. As for urgent and emergency procedures, the response must be immediate.
In cases of application procedures or services where the deadlines for compliance assurance are less than five days, the operator's response to the beneficiary should be given within the time limit set in RN No. 259, 2011.
"With the rules we are seeking to encourage adequately meet demand, ensuring access to and use of services, clear and accurate information about the contracted services and the immediate provision of information and guidance on the procedure or service requested. We intend to induce the production of increasingly rapid solution to the demands of beneficiaries, lower the deadline set in RN No. 259/2011, "says Simone.
Consumers can also request to send this information in writing within 24 hours and require re-examination of its request, which will be assessed by the Ombudsman of the company - another important novelty implemented the new standard. With that, it has the opportunity to appeal the negative inside the carrier. If the company difficult or try to prevent such review will be configured offense for non-compliance with the rules on service to beneficiaries in healthcare coverage requests.
DATA ACCESS - Operators must file for a period of 90 days, and available in print or electronic media, the care recipient data, identifying the numerical record of service, ensuring the custody, recording and maintenance record.
The beneficiary may request that the information provided will be forwarded by mail or electronic means, within 24 hours. If request, they may also have access to the records of their calls, within 72 hours after completion of the application.
FINE - In case of noncompliance with the rules laid down in the resolution rules, the operator is subject to a fine of $ 30,000. If the offense will be configured in negative coverage, the operator will also be subject to a fine - in this case, the values range from R $ 80,000 to R $ 100,000.
The Normative Resolution underwent public consultation and received over a thousand contributions of the whole society.
Check here the full text of the standard.
Measures
Better understand the measures.
Check the service deadlines set by the ANS.
Source: ANS
To access the ANS site, click here.
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This article was translated by an automatic translation system, and was therefore not reviewed by people.