Who can take a rapid Covid-19 test through their health plan?

Did you know that you can now take a rapid COVID-19 test through your health insurance plan? Read the text and learn about your rights!

At the beginning of the pandemic, health plans were not covering rapid testing to detect Covid-19. 

However, on January 20th, the situation changed. According to a resolution from the National Supplementary Health Agency, health plans are now required to cover this test.

In today's text you will be able to clear up some doubts about the subject, for example, how this coverage will work and who can do it. rapid test for Covid-19 through the health plan.

So, be sure to keep reading to stay informed about your rights. See our index below:

• Who can take a rapid Covid-19 test through their health plan?
• Is it possible to take the rapid test in pharmacies?
• Where can I take the exam?
• The operator refused to pay the refund, what should I do?
• Where can I go if the operator refuses to pay the refund, even though I am entitled to it?
• Conclusion.

Who can take a rapid Covid-19 test through their health plan?

To take the test under the health plan, it is necessary to present a medical request; however, the patient must have at least two flu-like symptoms or a case of Severe Acute Respiratory Syndrome.

The test must be performed between the first and seventh day after the perception of symptoms, which are:

• fever;
• loss of taste;
• olfactory disorder;
• cough;
• runny nose;
• headache;
• sore throat;
• chills.

Unfortunately, there are some rules regarding the public that the coverage serves, for example, a group that is not entitled to the test with coverage of the plan, are part of this group:

• children under two years of age;
• people who took the PT-PCR or rapid test less than 30 days ago and the result was negative.

Furthermore, people who present a medical request to return to work, because they are asymptomatic or to suspend isolation, for example, are also not entitled to health plan coverage for this purpose. 

Is it possible to take the rapid Covid-19 test covered by the health plan in pharmacies?

Yes. It's possible. If you have at least two of the symptoms mentioned in this topic, you don't need to go to a lab or clinic under your health plan.

If your doctor prescribed the test, the health plan is responsible for paying for it, regardless of where it is.

However, you need to be aware of what is in the contract, if it is written in that document that the client can do the rapid test for Covid-19 through the health plan at any establishment, ok. You can request a refund for the amount spent on the test.

Now, if this is not written in the contract or it was not specified, the situation may change.

Where can I take the exam?

Tests can be performed through the health plan company's accredited networks. If in doubt, it's important to check with your provider where the tests can be performed.

In any case, there is no need to request authorization in advance from the health plan operator.

In fact, the resolution makes it clear that authorization must be immediate.

If the client happens to take the test, the laboratory informs the operator and requests authorization, the response must be given immediately.

Furthermore, if the accredited laboratory refuses to perform the rapid test, the patient must inform the operator, only then will the operator be able to inform him where he should take the rapid test.

If there is no positive response from the operator or it does not indicate any place where the consumer can do the rapid test for Covid-19 through the health plan, He can simply take it elsewhere and request a refund for the exam fee.

The operator refused to pay the refund, what should I do?

First of all, before you look for another place to take the test, you need to be aware of what is in the contract.

It's important to consider the terms of each contract before making a decision. If your health plan doesn't provide reimbursement, you'll likely only be able to perform tests at accredited clinics or laboratories.

However, if the operator does not provide a location for the customer to take the exam, they can take it elsewhere and request a refund, as this is considered a service failure.

Another important point to note is that some contracts state that if the client takes the exam on their own, without a doctor's order, they are not entitled to a refund.

The insurance company may pay, but it's not obligated to. Now, what are the chances of it paying if there was no medical request?

So, always pay attention to the clauses in the contract, especially before signing.

Where can I go if the operator refuses to reimburse me, even though I am entitled to a refund?

If you have any issues with your health plan related to this new resolution, including reimbursement, it's best to report it to the ANS.

You can inform the Agency about the situation through website or telephone: 0800 701 9656.

Furthermore, if your consumer rights are being violated, you can also contact consumer protection agencies, such as Procon.

Conclusion

As the resolution is still recent and health plans are still adapting to the changes, you may encounter some difficulty or resistance when making the decision. Covid-19 test by the health plan.

However, know that you are within your rights and must appeal if they are violated.

Finally, be sure to check out our recommended reading: digital bank N26 arrives in Brazil.