Post by messi05 on Jan 23, 2024 22:48:09 GMT -7
Expectation resulting from the promise made and the deficient information, and the subsequent refusal to comply, gives rise to a large part of the disputes in the sector. In the offering of popular health plans, whose natural vocation is aimed at people with lower income and social status, the tendency for this structural informational deficit to worsen in the relationship between the consumer, the intermediary that contracts on behalf of the operator, and the operator itself, that he must fulfill the contract, seems elementary. However, the main issues involving disputes between consumers and health plan providers have been well known for some time.
They concern refusals to cover procedures, the Buy Phone Number List disqualification of professionals and health establishments originally planned (and which often contributed to the decision to contract the plan or operator), and the difference in rules between collective and individual health plans in the regarding the adjustment of monthly fees and the possibility of unilateral termination of the contract. In the case of denial of coverage, the main issues involve the delay in authorizing procedures, the requirement for high percentages of co-participation from the consumer and the exclusion of coverage for procedures whose advances in science and technology make it part of the consumer's legitimate expectations (such as This is the case with organ transplants).
In relation to the de-accreditation of professionals and healthcare establishments, it is noted that the consumer's own interest in contracting is guided by a certain plan or operator, often in view of the professionals and hospitals offered. Its change, throughout the contract, although admitted, cannot frustrate legitimate interests in relation to a certain quality expectation, or even cause harm or discontinuity to ongoing health treatments and procedures to which the consumer is subjected. As for the third point, the lack of equality in relation to individual and collective health plans, its most visible face is the almost absolute prevalence of the offer of collective plans in the market, considering the freedom of readjustment, regardless of authorization from the ANS; and likewise, the possibility of unilateral termination of the contract by the operator.
They concern refusals to cover procedures, the Buy Phone Number List disqualification of professionals and health establishments originally planned (and which often contributed to the decision to contract the plan or operator), and the difference in rules between collective and individual health plans in the regarding the adjustment of monthly fees and the possibility of unilateral termination of the contract. In the case of denial of coverage, the main issues involve the delay in authorizing procedures, the requirement for high percentages of co-participation from the consumer and the exclusion of coverage for procedures whose advances in science and technology make it part of the consumer's legitimate expectations (such as This is the case with organ transplants).
In relation to the de-accreditation of professionals and healthcare establishments, it is noted that the consumer's own interest in contracting is guided by a certain plan or operator, often in view of the professionals and hospitals offered. Its change, throughout the contract, although admitted, cannot frustrate legitimate interests in relation to a certain quality expectation, or even cause harm or discontinuity to ongoing health treatments and procedures to which the consumer is subjected. As for the third point, the lack of equality in relation to individual and collective health plans, its most visible face is the almost absolute prevalence of the offer of collective plans in the market, considering the freedom of readjustment, regardless of authorization from the ANS; and likewise, the possibility of unilateral termination of the contract by the operator.
Thank you for joining and posting emilyv!!