Since the starting of the yr, Brazilians have been speaking about what exams and coverings ought to or shouldn’t be finished with well being plans. The debate gained energy from the Supreme Court of Justice (STJ) evaluate of the record of obligatory procedures and, now, it revolves round a bill in the National Congress.
In June, the The Supreme Court of Justice understood that the record of procedures lined by well being plans have to be exhaustive. This means that plans should solely cowl remedies that are listed by the National Complementary Health Agency (ANS).
According to the resolution of the STJ, providers not included in the ANS record are thought-about non-obligatory. But bill No. 2033/22 to change this rule once more.
oh textual content accepted final Wednesday (03) in the Chamber of Deputy Ministers establishes sure assumptions to cowl well being examinations and coverings that are not included in the record of ANS procedures and occasions.
This means that, if the bill comes into pressure, some remedies have to be thought-about, in sure circumstances, as obligatory though they are outdoors the ANS record.
The bill goals to proceed with remedies that could also be excluded from medical health insurance.
What are the changes if the bill is accepted?
According to the textual content, operators should authorize well being plans to cowl therapy or procedures prescribed by a physician or dentist who just isn’t on the ANS record, so long as it meets one among the specified standards. Are they:
– There is proof of effectiveness, in accordance to well being sciences, primarily based on scientific proof and a therapeutic plan;
– There are suggestions from the National Commission for the Incorporation of Technologies in the SUS;
– There is a suggestion from no less than one well being know-how evaluation group that has a global fame, whereas they are additionally accepted for his or her nationwide friends.
The bill handed in the House will go to the Senate. After being mentioned, it will likely be voted on and, if accepted, should nonetheless be accepted by the President of the Republic.
What is the record of ANS procedures?
The ANS record of necessary procedures and coverings was created in 1998 to set up minimal protection that couldn’t be denied by well being plans. The record has since been up to date to embrace new applied sciences and developments.
Since then, it is not uncommon for shoppers of well being plans to search in courtroom the proper of operators to pay for procedures or remedies that are not but on the ANS record.
READ: Health plans: learn the way to seek the advice of the record of ANS procedures
The record of ANS procedures lists 3,368 well being providers, together with consultations, exams, remedies and surgical procedures, in addition to drugs and orthoses / prostheses associated to these procedures. These medical providers have to be provided in accordance with the well being plan.
* With info from Agência Brasil.