Imagine precisar fazer um exame, um procedimento, que pode ir de um simples raio X a uma tomografia ou uma cirurgia e, quando vai agendar, o seu plano de saúde se nega a realizá-lo, alegando não ter cobertura.
Você já deve ter ouvido muitas vezes sobre negativa das operadoras de saúde.
Mas você sabe como ela deve ser feita?
Segundo a resolução normativa 395 da ANS, havendo negativa de autorização para procedimento solicitado por profissional da saúde devidamente habilitado, seja ele credenciado ou não, a operadora deverá informar ao beneficiário detalhadamente, em linguagem clara e adequada o motivo da negativa de autorização do procedimento, devendo ainda indicar a cláusula contratual ou algum dispositivo legal que justifique a negativa.
Saiba ainda que, o beneficiário pode requerer a justificativa da negativa de cobertura por escrito, para isso ele deverá realizar a solicitação com o plano de saúde e a operadora irá gerar um número de protocolo.
Saiba ainda que, o beneficiário pode requerer a justificativa da negativa de cobertura por escrito, para isso ele deverá realizar a solicitação com o plano de saúde e a operadora irá gerar um número de protocolo.
A operadora deverá encaminhar a justificativa por correspondência ou por meio eletrônico, conforme o beneficiário tiver escolhido.
O prazo máximo para justificar a negativa por escrito é de até 24 horas após a solicitação.
16 comentários em “Como deve ser a negativa do plano de saúde?”
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