Editora Roncarati – ANS speaks out against the obstacles that health workers face in the reimbursement process

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With reference to the article published in Journal or Globo on Tuesday (14/05) – “Health plans limit reimbursements to cut costs.” (https://oglobo.globo.com/economia/defesa-do-consumidor/noticia/2024/05/14/planos-de-saude-limitam-reembolsos-para-redutor-custos-entenda-o-que-muda- nas-operadoras.ghtml), the position of the National Agency for Supplementary Health (ANS) on the increasing difficulty in requesting reimbursement from healthcare providers seemed clear and objective to us.

The requirement of proof through CNES and requesting documents not stipulated in contracts are questionable practices. According to the National News Agency, there is no justification for operators to require, for payment purposes, that the health institution be registered with the French National Center for Spatial Studies.

Furthermore, the agency emphasizes that the beneficiary does not have the right to check whether the health institution providing the services is registered with the National Center for Environmental Studies.

The ANS Memorandum highlights the importance of respecting contractual terms and avoiding imposing responsibilities on the consumer that are not their responsibility.

These operator practices have practical and important implications for the care of patients who have paid for their health insurance plans for years. Creating obstacles to licensing or paying for treatments to which patients are entitled creates emotional and financial stress, and in some cases can even jeopardize the health of beneficiaries.

It is crucial that operators act in accordance with applicable regulations, ensuring fair and timely access to contracted health services.

Institute of Health Ethics

source: Institute of Health Ethicsdated 05/14/2024.