Prepaid Health Clinics

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Jan 06, 12

Prepaid Health Clinics (PHC) provide plans that are highly acceptable to the public and have no health insurance category, and are not our regular HMOs or PPOs, although the same as explained above these PHCs are strictly regulated by the state and are governed by the same laws of HMOs. In fact the State itself in the current legislation recognizes the similarity of both HMO and PHC. In fact the big HMO, PPO and health insurance have had no choice but to reconsider their marketing strategies and make plans at prices like these PHC. The PHC workers have caused them serious problems and the PHC are much cheaper than an HMO or traditional PPO and accept pre-existing health conditions, among others benefits. Neither do I mean it to be the best option. It depends up to where you want to spend or up to where your pocket allows.

6 reasons for making a health insurance thanks to the 2012 Budget

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With the 2012 state budget, public health will be more expensive. Consider:

- Emergency Hospital in moderate rate – up to € 49.00 (starts at € 9.60)

- Fines for non-payment of user fees – between € 50.00 and € 250

Never before have warranted the hiring of a health insurance. Read the six main reasons:

1 – Within the network (AdvanceCare, Multicare, …) paid by consultation between € 10 to € 15 or a percentage (10% or 20%), ancillary tests are reimbursed between 80% to 90% or a rate of € 10

2 – Drugs can be reimbursed at 80%

3 – Served quickly (days) and operations are done in less time than the public sector. In the public sector may have to wait months for an appointment.

4 – There are already solutions that cover Serious Illness with no concern of the ceiling of the hospital to be insufficient to treat the disease

5 – There are already solutions without age limit of stay

6 – There are no fines for late payment of user fees since the fee is paid to the head (see item 1)

If only considering childbirth and an urgent operation (immediate), the public sector is more advantageous, in my opinion, because the life support equipment are more complete in public hospitals.

New procedure for reimbursement of medicines by the NHS

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Procedure for refund of expenses submitted for reimbursement of medicines, resulting from the mandatory electronic prescription drugs as a prerequisite for obtaining a construction from the State, established by Decree Law No. 106-A/2010 1 October and regulated by the Ordinance No. 198/2011 .

The defined in Ordinance No. 198/2011 expressed by the existence of mandatory electronic prescription application for reimbursement of medicines in the NHS by the pharmacies.

This provision is however revoked in the following exceptional circumstances :

a) Prescription at home;

b) failure of the electronic system;

c) Employees with prescription volume equal to or less than 50 recipes per month;

d) In other exceptional situations of proven unsuitability, preceded by registration and confirmation in the respective professional body.

For these four situations is allowed to use manual prescription by the doctor, however being obligatory that appears at the very mention of prescription exceptional situation .

The ADV examines this requirement on the cost of drugs subject to refund, when prescribing a manual before, emitted from 01/08 and application of reimbursement by the NHS Pharmacy.

Where this requirement is not met, the expenditure is returned to the insured requesting the missing information.

Insurers access to clinical data, even after death

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This news was published in the Official Public 28/03/2011 and reproduce in its entirety in italics, to be of public interest (the underlined and bold are mine):

Insurers are able to access clinical data of their customers, essentially the life insurance underwriters, after their death, based on authorization clauses placed in the middle of the insurance contracts.

This form of consent has been enough to Commission on Access to Administrative Documents (CADA), which in many cases, has allowed public hospitals to provide the health data of their patients. However, the National Data Protection Authority (CNIL) has a different understanding, not considering this form of valid consent.

For the access is authorized requires that the customer has signed a specific clause, separated from the rest of the contract, which makes the citizen is fully aware that to allow the consultation of sensitive data.

The Differences of opinion are still creating unequal treatment depending on the health care used, since EVERY may only intervene in cases involving public institutions . The private hospitals are outside the purview of this committee, are therefore, citizens subject to greater protection of their clinical data, when they resort to this sector .

The president of the ICPD, Luis Silveira, regrets the confusion and calls on Parliament to resolve the issue that is making citizens “bewildered and insecure.” The president of CADA, Jose Antonio Goldfish, maintains that the ICPD is not competent to examine access to health data in the public sector, after the entry into force of the new law on access to administrative documents (LADA) in 2007. This is because the law stipulates that access to administrative documents “contain information such as health,” is governed by that law.

Luis Silveira challenges the tacit revocation of the competence of the committee which he chairs, while recognizing that LADA is after the Law on Protection of Personal Data, 1998. “Both are Acts of Parliament and the ideal is that the Parliament legislated in order harmonic. But we must not forget that the Law on Personal Data Protection is the transposition of an EU directive, which states that health data are sensitive and as such will have to be an independent entity created for this purpose, the ICPD, to regulate the access, “said Luis Silveira. He adds: “On the other hand, the Constitution also guarantees the protection of personal data. But a law can not override a directive and the Constitution, even if it is later than these. ”

Paula Lobato Faria, an expert in Health Law and professor at the National School of Public Health, says there is a conflict of laws, but believes a “legal artifice” to say that clinical processes are administrative documents. “If so, we have two laws for the protection of personal data and a specific health and genetic information, which focus exclusively on this issue?” Furthermore, it considers unconstitutional to have different levels of protection in clinical processes only because one is in the public sector and another in private. Paula Lobato Faria argues that the consent must be express and specific access to health data. “Do not just put it in a cake a clause in the midst of an insurance contract” he says.

Louise Neto, constitutionalist and university professor, believes that the authorization clauses tucked in the middle of the insurance contract “is void and can not be considered.” This is because the data protection law requires that consent be free, specific, informed and express. Jose Antonio Goldfish disagrees and says that the clauses are valid until eventually be annulled by the courts, adding that each is preparing an opinion on the issue of consent. A position that neither responsible for the legal services of the Portuguese largest insurer, Fidelity Global, agrees. Isabel Lage believes that consent is a necessary and specific to the data access of health after the death of patients.

Luis Silveira recalls that there is an economic disparity between the insurer and the insured and warns: “Sometimes people think that we try to not allow access to data they are making life difficult, but do not realize what insurers want is eventually arrange in a clinical reason for not paying. ”

While no one would understand, my advice is not to omit anything when you do a life insurance or health, because in case of death, the insurers will sift through everything, even if you had the disease for 30 years and did not mention …

How could one assume that the insurer declines from car accident

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11/08/2010 A client of mine had an accident a car off a highway. I had car insurance for themselves harm.

The car was an expert and it was found that had not been inspected in June, when it should have been.

Lack of inspection is grounds for the insurer to take the accident, as I explained in an article earlier.

Under the conditions of the general auto insurance, could find an opportunity that allowed me to address the insurer as follows:

- I told the company’s procedure for the management of vehicles

- I asked the client to review invoices and maintenance of the vehicle, as well as bills of Via Verde

- Appeal to common sense is forgotten as the insurer for inspection.

The insurer decided, based on my presentation, review the process.

In 18-12 days, I received an email stating that the insurer would take responsibility.

Just the best and I am sure that the customer is satisfied.

There are times when I feel very proud of the work. Cost, but I did!

The s and my clients will have to end support in solving problems . As exemplified in this particular case.

This was a case that, in its specificity, is justified to share with you. For who knows how it works in Accive .

For these and other I have 23 testimonies of customers satisfied with the work.