“If we exclude that the reason for this is the inability of Rbm operators and consultants, only one hypothesis remains: all this is based on ajoint action to bully the member, harass him by any means and with the sole aim of inducing him to waive the refund. In short: go all out for do not pay“. The outburst of a consumer customer of Intesa Sanpaolo Rbm Health effectively summarizes what was reported by Other consumption the Antitrust Authority, which in turn imposed a fine of 5 million euros for unfair commercial practices, while to the supplier of Rbm, the provider Previmedical, it was asked 1 million euros.
The examples cited in the provision of Competition Guarantor at the expense of the company that today defines itself as “the Health Insurance that puts the Person to the Center“. The most classic is that of dental expenses, a category already quite thorny to be reimbursed. Well, a policyholder of Rbm reports that for a practice relating to a dental intervention opened on 15 December 2020, first he was asked to supplement the medical prescription, then an X-ray report, and finally a correction of the invoice. Despite having completed the entire obstacle course, the reimbursement practice was ultimately rejected on the general grounds that the integration would not have been carried out correctly.
Another customer reported that an authorization request dated January 27, 2021 to perform a dental implant was answered by a request for document integration arrived the following February 19, on the same day fixed for the surgery, moreover 15 minutes after the time of the appointment. For this reason, he considered the will of the insurance company to be “evident procrastinate as much as possible the processing of the practice in order to prevent the performance of the service within the time agreed with the doctor “.
Another policyholder was asked instead to integrate the documentation with a “certificate, issued by a specialist doctor, certifying the date of application and removal of the brace / plaster“. Too bad that the consumer had undergone surgery of removal of a malignant carcinoma a kidney, which cannot include the application of a brace / cast. A consumer was then asked for the first aid report for an injury that resulted from a structural degeneration of the joint and not from trauma, as the attached documentation testified.
In the parade of misplaced answers, the case of rejection of the reimbursement relating to a cannot be missed swab for Covid-19 with the motivation that “the deadline for the resubmission of the healthcare expenses pertaining to 2019 expired on 30 June 2020 “, in front of which the consumer wonders if Previmedical is aware of the fact that the tampons in question were made starting from the second half of 2020.
It doesn’t stay out there either‘oncology. For example, two other policyholders were denied reimbursement by opposing a “purpose aesthetics“Of the required services. One was thesurgical excision – following a specialist visit and epiluminescence – by in the atypical in patient with familiarity for the melanoma and the other was surgery breast implant replacement for accidental breakage following trauma (certified by the doctor).
Again in the oncology branch, but in the field of pre-authorized voucher services, the complaints of the policyholders – one third of the customers of the Intesa company are members of the health fund of metalworkers Metasalute – complain about the difficulties encountered in obtaining authorization for services involving cycles of several sessions. So physiotherapy, but also radiotherapy, for which it is necessary to enter a request for each session.
As far as policyholders are concerned, “in the case of a course of radiotherapy prescribed to a cancer patient, Previmedical authorized only the first session, subordinating the subsequent ones to confirmation from time to time to the same professional as the presence of the patient by the hospital
and to contextual telephone communication by the patient on the date of the next session (that of the following day) ”, explains the Guarantor. A procedure so difficult that theEuropean Institute of Oncology he refused to follow her.
The company’s reply was that the choice “would be due to the fact that the cycles of care may have one duration exceeding the validity of the policy, with the consequent need to verify that, when the service is performed, the policy is active and the duly paid premium“. The reconstruction, continues the Antitrust Authority, “is denied by the documentation acquired during the inspection, which shows that ISP RBM has given indications to the Provider to authorize such therapies per session and not per cycle of care to carry out a more effective control of spending. The control of spending, as achieved, has had negative repercussions on the continuity of services, beyond any legitimate cost containment criteria. Insured persons who undergo cycles of radiotherapy or physiotherapy complained that “with the system of confirmation of individual vouchers [è] very difficult / impossible comply with medical prescriptions“As, once the first session was carried out, they were forced to communicate to Previmedical the date of the next session (often that of the following day), also addressing the difficulty in contacting the operations center”Of the company.
That in the end he must have understood the hint, if in May 2021 changed the practice by allowing a single authorization for the entire cycle of care. The awareness that something was not going as it should, after all, has spread even earlier if, as stated in an inspection report, a manager of the company on March 17, 2020 urged the liquidators to “verify the merits the documentation attached to the refund requests and especially to the certified e-mails because a repeated denial, not supported by evidence or valid arguments and disavowed by a simple reading of the contract and documentation sent to us, exposes the company to a reputational risk not insignificant”.
Holy words, not so much because the company of the company is over under accusation system bank by definition, which following the provision specified in a note that the disputes “refer mainly to the period July 2018 – July 2020, prior to the acquisition of Rbm Salute by Intesa Sanpaolo Vita, theMay 11, 2020 with the birth of Intesa Sanpaolo Rbm Salute ”. And he pointed out how theindex of Ivass complaints of Intesa Sanpaolo Rbm Salute has gone from 12.94 complaints every 10,000 contracts in December 2018, to 3.94 complaints every 10,000 contracts in June 2021.
What is damaged by the story, however, is above all the intense lobbying that insurance companies have been conducting for at least a decade to be able to integrate the health system with their policies, constituting the so-called third pillar health that in the dream book of politics that goes hand in hand with insurance, should make a fundamental contribution to restore the health rights of all citizens. Obviously after that of the category funds, the second pillar, which in turn rely on private insurance to protect the health of their members. Just like Metasalute which alone represents one third of Intesa Sanpaolo Rbm’s customers.
The issue is obviously also dear to Rbm, whose CEO Marco Vecchietti recently stated that “one of the important lessons that the pandemic is that to solve most of the problems induced by this emergency, which can also occur in situations of greater pressure on the health system other than this, it should be assigned to the Integrative Healthcare a “institutional” role to support the National Health Service “. According to the manager who has led Rbm since before the arrival of Intesa, “the supplementary policies, in fact, bring a double level of protection for citizens: not just a economic support to support the costs of care at your own expense, but also the personalized access guarantee to a network of affiliated structures and to producers / suppliers of health supplies and means of supply other than those of the National Health Service “.
Rbm in 2020 grossed about 495.3 million euros in premiums for an operating profit of almost 61 million euros, last year it was “among the companies with the worst indicator in the claims classification for the non-life sector (excluding motor liability) ”, as the Antitrust points out.
Finally, the fact that the company has opposed the Authority not to have economic relations with the consumer protected by the Consumer Code, since the contract is signed with companies or health funds. Isp Rbm, replies the Guarantor, “however establishes an economic relationship with the user protected by the Consumer Code. The consumer, in fact, even if a third party with respect to the contract between health funds and professional, is the subject whose interest is the cause of the same. negotiation relationship. The intervention of the health fund in the purchase of the insurance services of the Company is therefore not suitable to exclude the application of the legislation on unfair commercial practices, taking into account that the final recipient of this relationship and the user of the service is still the consumer ” .