publicado em 04/12/2012 às 17h50:00
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Health plans: working conditions of medical harm consumers

Joana Cruz, a lawyer for the Brazilian Consumer Defense (IDEC).

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Foto: Idec
Joanna Cruz, an attorney from the Brazilian Institute of Consumer Protection
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Joanna Cruz, an attorney from the Brazilian Institute of Consumer Protection

For some time the relationship between plan operators and their health insurers and providers is under discussion because of the situation of doctors accredited to these companies.

Practitioners claim adjustments of fees for doctors in larger amounts and at intervals stipulated in the contract and the order of interference unethical operators in the doctor-patient relationship. Because of the lack of progress in the dialogue with businesses, professionals adhere to a National Protest medical grade between 10 and 25 October.

The working conditions of doctors accredited plans and health insurance directly interferes with the quality of services provided to consumers. The low value of medical fees paid by companies makes the professionals have to meet a greater number of patients at a time, which often makes the query time is less. Still, it is known that many companies request made to interfere with exams and other procedures, challenging the necessity of performing and directing these professionals not demanding a large number of procedures to cover. Not least, is a significant number of accreditations providers of health insurance plans.

The regulatory measures taken by the National Health Agency (ANS) have been unable to prevent the damage to the health of consumers, according to a survey by the Associação Paulista de Medicina / Datafolha released in August this year. In Sao Paulo, eight in ten respondents - about 7.7 million people - had some trouble in the past two years, an average of 4.2 problems per person. At least 100,000 consumers entered in court against health plans in Sao Paulo, according to pesquisa1.

On account of the above, Idec supports the national health movement and believes that operators should ensure better working conditions for these professionals, along with the correct delivery of health care services to patients, without, however, be transferred to consumers liens arising from any costs resulting from negotiation with providers, considering that the monthly services are already highly readjusted, including values ​​above inflation, which characterizes obligation excessively burdensome to the consumer, in the light of the arts. 6, IV, 39, and 51 V, & 1, III of the Consumer Protection Code.

Still, during the medical stoppage, the consumer must have their rights respected, especially regarding the care guaranteed by the deadlines stipulated by the ANS Normative Resolution. 259, 2011.

Thus, the consumer has the right to care within the maximum waiting time determined by ANS, regardless of medical stoppage. Consumers should contact your provider or health insurer and request the guarantee of access to the procedure within the time required under the penalty if the company does not provide access to any professional, accredited or not, the professional look of your preference and be repaid within 30 days after the request.

Source: IDEC
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