Health plans can pay for services without notice Accredited

One of the main complaints against the health plan's accreditation services, doctors and other professionals in the industry without consumers being warned in advance - at the risk of having to pay for procedures they believed to be covered by the company.

To avoid this kind of problem, even when the disqualification occurs during a hospitalization or treatment, Senator Antonio Carlos Valadares (PSB UP) filed a bill requiring health plans to reimburse the costs when this happens.

According to the proposal disqualification, not only professionals but also of health services - must be communicated to consumers at least 30 days in advance. Otherwise, the health plan must make the refund of the amount paid for the service. The text also provides for reimbursement when the consumer receives incorrect information on the coverage of its network. Justice has determined the service by health plans in some cases of disqualification.

The project still requires reimbursement when health plans fail to comply with the deadlines set by the National Health Agency (ANS) for medical care, exams and other procedures. Companies also would have to make payments when denying coverage to health procedure or event that is on the list drawn up by the NSA.

The bill, amending Article 12 of the Law 9.656/1998, will be evaluated in two Senate committees: first, the Economic Affairs Committee (EAC), currently being processed, and then the Social Affairs Committee (CAS) . If passed by the Senate, the text is then analyzed in the House of Representatives.

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