Since the beginning of the year, Brazilians have had discussions about which tests and treatments should or should not be done by health plans. The debate gained strength from the Supreme Court of Justice (STJ) analysis on its list of mandatory actions, and now it revolves around a bill in the National Congress.
In June, it was The Supreme Court of Justice recognized that the list of measures covered by health plans should be comprehensive. This means that plans are required to cover only treatments listed by the National Supplemental Health Agency (ANS).
According to STJ decision, services not included in the ANS list are considered optional. But Bill 2033/22 could change this rule again.
a The text was approved last Wednesday (03) in the House of Representatives It makes some hypotheses to cover health examinations and treatments not included in the ANS’ list of procedures and events.
This means that if the law comes into force, the provision of certain treatments, in specific cases, should be considered mandatory even if they are outside the ANS list.
The bill aims to continue treatments that could be excluded from health insurance coverage.
What changes if the bill is passed?
According to the text, operators must authorize health plans to cover treatment or procedures prescribed by a physician or dentist who are not on the ANS list, Provided that it meets one of the stipulated criteria. are they:
– Evidence of effectiveness in the light of health sciences based on scientific evidence and a treatment plan.
– There are recommendations from the National Committee for the Integration of Technologies in SUS;
There is a recommendation from at least one world-renowned health technology assessment body, provided that it is also endorsed by its national counterparts.
The bill passed in the House of Representatives will go to the Senate. After it is discussed, it will be voted on, and if approved, it must still be approved by the President of the Republic.
What is the list of ANS procedures?
The ANS List of Mandatory Procedures and Treatments was created in 1998 to establish the minimum coverage that health plans cannot deny. The list has since been updated to include new technologies and developments.
Since then, it is common for users of health plans to request in court the right of operators to pay for procedures or treatments that are not yet included in the ANS list.
The ANS 3368 Procedure List lists a health service, including consultations, exams, treatments, and surgeries, as well as medications and orthotic/prosthetic devices associated with these procedures. These medical services must be provided in accordance with the health plan.
*With information from Agência Brasil.
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