FNO » Negar pedidos de exames feitos por dentistas é ilegal, diz ANS

AGO

2014

Negar pedidos de exames feitos por dentistas é ilegal, diz ANS

by FNO

Clientes de seguros de saúde reclamam que operadoras estão negando exames quando os pedidos são feitas por dentistas. A Agência Nacional de Saúde Suplementar (ANS) assegura que essa negativa é ilegal.

Rafael descobriu da pior maneira possível que carimbo de dentista vale menos do que carimbo de médico. Pelo menos para o plano de saúde dele, que negou o pedido de exame feito por sua cirurgiã-dentista.

Foram quase três meses de luta até conseguir fazer o exame, que confirmou a necessidade da cirurgia.

“A gente tem que ficar brigando, se estressando para ter o seu direito atendido”, afirma o representante comercial Rafael Frade.

Janaína transformou a recusa do plano de saúde em caso de polícia. Ela não conseguiu fazer nem um exame de sangue nem um raio-x. Os dois foram requisitados por sua cirurgiã-dentista, antes de uma operação. A paciente registrou a não prestação de serviço na delegacia.

“Uma vergonha! Não tinha necessidade. A gente paga caro um plano de saúde para quando você precisar, você ter para usar e você precisa, você está em dia com o seu plano, e você não pode usar”, disse a motorista Janaína da Cunha.

Doutora Katyuscia Lurentt perdeu a conta de quantos clientes se queixam do mesmo problema. “O maior problema é moral. O paciente me ligando falando: ‘Doutora, não aceitaram seu carimbo’. É como se tudo que eu tivesse feito, meus cinco anos de faculdade, meus três anos de residência, tivesse sido jogado no lixo”, afirma a dentista.

A cirurgiã-dentista gravou uma conversa telefônica em que a funcionária de um laboratório nega a realização de um exame porque o carimbo é do Conselho Regional de Odontologia (CRO) e não do Conselho Regional de Medicina (CRM).

Gravação: De CRO, a Golden Cross não vai autorizar pra fazer o exame.
Katyuscia Lurentt: Mas por que que não?
Gravação: Porque é CRO. Se fosse CRM, autorizaria. CRO a Golden Cross não autoriza.

A Agência Nacional de Saúde Suplementar assegura aos cirurgiões-dentistas o direito de requisitar exames. Eles estão protegidos por lei federal e por uma súmula normativa publicada pela própria agência há sete anos. A ANS classificou ainda de ilegal qualquer recusa das operadoras de saúde em prestar atendimento aos clientes desses profissionais.

“Nós só podemos imaginar que isso seja de fato mais uma tentativa que algumas operadoras, as más operadoras, tendem a postergar o acesso de um usuário ao que é o seu direito, que é fazer o procedimento”, declarou o diretor-adjunto da ANS, João Luís Barroca.

Em nota, a Golden Cross informou que, de acordo com a própria agência, as solicitações de pedidos de exame dos profissionais de saúde somente devem ser feitas de acordo com sua especialidade.

O diretor da ANS criticou a operadora. “De jeito nenhum, um usuário pode ter exame negado, de acordo com a especialidade do seu médico que solicitou ou mesmo do seu odontólogo. Isso não pode ser motivo de negativa de cobertura. Agora certamente nós vamos procurar a Golden Cross para que ela nos explique esta novidade”, disse João Luís Barroca.

Quando o seguro nega um exame a que o cliente tem direito, a ANS pode multar a operadora em R$ 80 mil para cada caso.

Saiba mais: http://glo.bo/1kjrIoB

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