Clipping of news on Brazilian Culture, Law and Citizenship
22/11/2012
This article was translated by an automatic translation system, and was therefore not reviewed by people.
The beneficiary is entitled to reimbursement when the hospital refuses to meet a patient with immediate life threat
SAO PAULO - Many believe that beneficiaries can receive reimbursement when consultation with a physician not certified to a health plan, others argue that carriers do not offer to return the money spent on consultation.
Especilaistas remember that everything depends on the type of health plan contracted, but usually no health plan entitles you to a refund, except in emergencies, emergency or unless it is possible to use the services themselves, contracted, credentialed or referenced from operators.
However, if the beneficiary is at risk of immediate life and accredited hospital refuses to meet the patient, it may seek another health center that is not listed operator and seek reimbursement later.
No refund
Beneficiaries may consult with your doctor, or else prefer to perform an examination at a clinic is not accredited, the law does not grant you the right to reimbursement, says the Association. However, if your health plan offers the free choice option, in which the consumer can choose the doctor or hospital of your choice, is allowed to request reimbursement from the carrier's plan.
But we must be aware that the value will be repaid in part and not full, and the "ceiling value" of each repayment will vary according to the contract plan.
Term
Experts still recommend staying attentive to contractual deadline to request a refund, which is usually 30 days after the consultation. Besides these rules avail only to contractors from January 1999. While the contracts prior to this date must comply with what is established in the contract.
Source: Everyday Health
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This article was translated by an automatic translation system, and was therefore not reviewed by people.