ONDONTOLOGIST, as a health professional, to perform the appropriate treatment of the patient, often need imaging tests, such as tomography and magnetic resonance imaging. However, what not everyone knows is that these tests, Procedures of the National Health Agency (ANS) may be requested by ONDONTOLOGIST, even if the patient has an outpatient plan, that is, that does not have dental coverage. Based on art. 12, item II of Law 9,656 / 98, health plans used to be deny the coverage of the exams, just because they have been prescribed by ONDONTOLOGIST. However, since 2007, through Normative Ruling No. 11, the ANS ratified the competence of this professional to request additional examinations, such as imaging, in verbis :

Request for planned laboratory / complementary examinations in art. 12, item I, letter b, of Law No. 9,656, of 1998, and the procedures covered by hospital admissions, buco-maxillofacial nature or by clinical imperative, in art. 12, item II, of the same law, and in art. 7th, sole paragraph of Resolution No. 10 of 1998, should be covered by the operators of private health care plans, even if when promoted by the assistant dental surgeon, qualified by the respective class councils, provided that they are purpose of a dental nature. "

Normative Resolution nº428 of 2017 of the ANS, updates the Procedures and Events in Health and constitutes the basic reference for assistance in private health care plans. This Resolution expressly provides in art. Paragraph 5, Paragraph 1, which examinations and auxiliary techniques dental diagnosis, treatment and prognosis may be requested or performed directly by ONDONTOLOGISTA, among them, the bare- maxillofacial and other specialties of dentistry.

How to proceed with the negative of the health plan?
Firstly, it is necessary to take into account the reason for the refusal, since may be different from what is exposed here. If the denial has occurred solely and exclusively because of the request performed by ODONTOLOGISTA, for the best solution to the impasse is recommended to seek the Health Care Service (SAC) of the health plan, exposing the facts, the rules set out above and the urgency of carrying out the procedure. If there is no satisfactory return, the second way is to seek the ANS through your website (www.ans.gov.br) , because this agency has mechanisms of mediation between the consumer and the operator. Thus, the patient, in the most of the time, you can solve the problem by using virtual communication without loss of time or greater wear.

Finally, if the above means prove to be insufficient, it is necessary to seek the lawyer of his confidence to, if necessary, judicially compel the company to comply with the legislation in the spotlight.

Text by Ane Saraiva. Legal Consultant in Health. Advocate of the Law Giesta & amp; Galvão - AGG. Graduated in Law by the Federal University of Pernambuco - UFPE. Post-graduated in Tax Law by the Institute Brazilian Tax Studies - IBET