September 29, 2022

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By ANS decision, will customers return to the plan?  ask questions

By ANS decision, will customers return to the plan? ask questions

The National Supplementary Health Agency (ANS) decided on Monday (4) that Emile resumes wallet From individual and family health plans transferred to the APS (Personal Healthcare) operator. The regulatory agency also halted the sale of the controlling company’s stake to A group of businessmen.

But what about the lives of the Convention clients? Can the tests be performed normally? Can Emile reverse the case?

a UOL Talk to health professionals Marcos Patolo, from Vilhena Silva, and Renata Farah, from Farah Kanda, and they provided these and other answers. Check it out below:

What does ANS resolution mean?

Amell must appeal the 340,000 health plans to customers in Sao Paulo, Rio de Janeiro and Curitiba.

The decision is a precautionary administrative measure. This means that it is temporary, that is, it may change after the appearance of Emil and APS.

“It’s a decision that seeks to avoid further damage,” says Batulo.

Several Amil customers have reported problems with the service after the transfer. in february, UOL Report cases Cancer patients left without care.

Will customers return to Emile immediately?

The decision takes effect immediately and the decision is that Emile gets that wallet back.

A period of 10 calendar days to show operators. Practically speaking, Emil has to inform clients of this new order change.

What happens to exams and procedures that are already scheduled?

Previously scheduled tests and procedures should remain unchanged.

In practice, consumers must have access to all treatments guaranteed in the contract. There should be no harm to the customer.

Can users face any difficulties in these next 10 days?

Yes, mainly administrative difficulties, such as, for example, knowing which call center to look for.

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“Since the ANS decided that Amil would appeal to the wallet, it makes sense that this operator would be the service channel once again to the beneficiaries,” Farah adds.

Will hospitals with non-accredited laboratories return to serve Amel clients?

Users who have been accused of network ineligibility can return to hospitals and labs that claimed they lost care.

Since Emile must return these contracts to what they were before the transfer, the approved network must be the same.

Batulo states that if the consumer is denied the service, he can collect documents that prove that he is entitled to a consultation or procedure in the authorized network.

They are valid as evidence, medical evidence and recent contracts, for example.

And if the problem persists, what should be done?

Customers have the alternative of registering a complaint in ANS . sitedetailing step by step what he encountered with Emile.

Another possibility is to file a lawsuit through a law firm that specializes in servicing HMO beneficiaries.

Should users worry about any point in the ANS resolution?

Customers should remember that this is not a final decision yet.

The operators Amil and APS will have a period of 10 days to submit their opinion to the ANS, when it decides whether to permanently cancel or adopt new measures in relation to these two companies.

According to Farah, the beneficiaries should pay attention to the fact that a third party, a group of non-UHG businessmen (United Health Group), the owner of Amil and APS, will take over the business.

“If the ANS definitively allows the transfer of beneficiaries to APS, and the latter maintains the change of control of the company with another company, there is a possibility that problems may arise in the provision of services,” he says.

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Is it possible that Emile can reverse the issue?

Everything will depend on what Emil And the APS Presented as a defense. However, the ANS He points out that the documents I have collected so far show that customers have been harmed.

The regulatory agency also notes that the company negotiating the company’s control of APS has not provided guarantees to maintain the operator’s economic and financial balance. If these possibilities demonstrate economic viability, the ANS may authorize the transfer because it understands that the beneficiaries and authorized service providers are at risk.