A resolution of the Regional Council of Medicine (CRM) of the Federal District amending the payment of medical fees by health plans has caused disagreements. From this Tuesday (18), when the resolution came into force, accredited medical plans are allowed to charge a customer if the operators fail to comply with new standards set by the board.

Under the new rules, health plans must pay the fees directly to the doctor and not through the private hospital. Moreover, the values ​​will be negotiated between the medical entities and operators of health plans. The resolution also provides that the physician can charge the patient directly to the private plan that does not comply with regulations.

"The medical representativeness, responsible for negotiating fees with doctors to health plans in the Federal District, to establish values ​​for the procedures and allow the physician to have the freedom to charge patients directly tied to covenants that do not agree to pay the established values" said article of the resolution.

The new standard took users by surprise. This applies to the cashier, Lenir da Silva, who sought orthopedic a private hospital in the city today (19) and withdrew after learning that consultation would have to pay $ 60. "I gave up and am looking elsewhere. We already paid a health plan expensive and often can not be met, "he said.

In a statement, CRM argues that doctors are charging users because operators are not complying with the standards. "In this period of adaptation, some plans still refuse to meet the terms established by the current standard. It is worth noting that in cases of urgency and emergency, the physician shall not withhold care, "the council said.

The resolution was approved in November 2010 and gave up within the last 17 days for the adjustment of operators.

According to CRM, carriers must pay for medical fees prescribed in the credential table Hierarchical Brazilian Classification of Medical Procedures, prepared by the medical profession. "It is worth noting that the new rules are designed to restore the dignity of the medical work in the private sector and thus provide a quality medicine to eliminate the payment of fees vis. Such a measure may even reduce evasion of accredited doctors to health plans, "it said.

In cases where the user has to pay the fee, the CRM reports that the patient should seek reimbursement from the plan. Estimation of the board is that 90% of plans have already joined the rules.

In a statement, the National Federation of Health Insurance, which represents 15 groups of health plan operators, said that the decision to charge for queries directly from the beneficiaries was taken unilaterally. "

For the director of the Department of Consumer Protection and the Ministry of Justice, Juliana Pereira, users should seek the services of consumer protection, because the resolution would be interfering in the relationship between client and plan. "The consumer, when it contracted health plan, he was offered a package of services such as consultation with the medical professional. It seems reasonable, does not seem appropriate to charge a fee out of contract. The consumer has no obligation to pay this value, "he said.

The prosecutor's office of Consumer Protection, Trajano Sousa, advises patients to keep the receipts for payment of the charge and attempt to redress via the health plan. In case of a negative operator, seek legal action. The prosecutor said he would discuss the matter with the operators. He criticized the resolution as "protecting the freedom of action of the doctor," for example, to forbid him to render service in an institution that contravene the resolution, "that should not be the central focus of CRM."

When contacted, the National Health Agency (ANS) which regulates the relationship between plans and consumers, said it is considering the issue for later manifest itself officially. The Association of Physicians of the Federal District said it will not comment.

On the last day on April 7, doctors accredited health plans across the country walked off for a day to require adjustment of fees. The information is the Agency Brazil.

Planos de saude

http://www.articlepool.com/author/blogfcinformacao