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Scheduling of appointments is great cause for complaint of health plans

08/01/2012

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

 

 



Amil, Unimed Paulistana and Green Line are the health plans with more negative coverage of records procedures
SAO PAULO - The scheduling of medical appointments were denied by the mode most health plans in the last three years, according to the NSA (National Health) provided the IDEC (Brazilian Institute for Consumer Protection).

Then among the denied requests by the plans appears a gastric (bariatric surgery) by laparoscopy or laparotomy (with guidance for use) surgical arthroscopy for meniscectomy.

Other procedures were also denied: meniscal suture, discoid meniscus remodeling, repair, reinforcement or reconstruction of the cruciate ligament or patellofemoral realignment, MRI of the cervical spine, dorsal or lumbar spine, and surgical treatment of disc herniation, among others.

According to the lawyer Idec, Joana Cruz, the above procedures are doubly guaranteed as mandatory coverage for hospital plans to consumers because they are provided in art. 10 of the Law of Health Plans and Procedures and the Role of Health Events in the ANS (RN 262/2011).

"It is worrying that the basic procedures for ensuring the health of consumers are among the most denied, such as medical consultations, deliveries and blood test (blood test)," said the lawyer.

The planes claimed
Amil, Unimed Paulistana and Green Line are providers of health plans with more negative coverage records of procedures to consumers from January to May this year.

In the first five months of 2012, Amil International Medical Assistance SA 1538 made negative coverage, while Unimed Paulistana Work Cooperative Medical Society, and the 1308 Green Line Health System SA, 1245 negative.

In 2011, the first three on the list were the same, changing only the placement. The carrier with the most negative was the Green Line (2295), followed by Amil (1804) and by Unimed Paulistana (1560).

In 2010, the operator who made the most negative coverage was Amil (1919), followed by the Pro-Health, in liquidation, (890), and Golden Cross (863).

"The repetition of the first placed in recent years shows that the illegal practice committed by these companies health is not being curbed, even with the regulation of the ANS," says Joana.

Resolution time
IDEC also questioned the degree of resolution of the problem, the mean time, the penalties imposed in case of impossibility of resolution, the amount of fines paid to the agency for negative coverage and breach of terms of service.

The information provided by ANS also showed that the median time to resolution of incidents recorded by the system NIP (Notice of Preliminary Investigation) was 29 days on average this year (until May).
In 2011, the time was 21 days.



Source: InfoMoney

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