O direito ao reembolso consiste na devolução, integral ou parcial, do valor pago pelo paciente em razão deste receber atendimento médico fora da rede credenciada ao plano de saúde.
Em regra, o reembolso é concedido somente em casos de emergência (com risco de morte) ou urgência (sem risco de morte); indisponibilidade de médico ou hospital; impossibilidade de acesso do paciente ao médico ou hospital da rede credenciada ou na hipótese de recusa de atendimento pelo plano de saúde.
Nestas ocasiões, uma vez solicitado pelo paciente, o plano de saúde possui o prazo de até 30 dias para realizar o reembolso.
Inclusive, é importante ressaltar que, atualmente, não há previsão legal estipulando o valor da devolução. Sendo assim, o cliente que deseja buscar o reembolso deve consultar a tabela de valores disponibilizada pela operadora de plano de saúde.
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