Specialists and family members of people with disabilities defended this Thursday (2), in a committee of the Chamber of Deputies, that the coverage of the list of procedures, medicines and exams by private health plan operators be interpreted and practiced more broadly, when necessary, than the list established by the National Supplementary Health Agency (ANS).
The public hearing for the debate in the Social Security and Family Commission of the Chamber took place in the face of the forecast of resumption of judgment by the Superior Court of Justice (STJ) on the list of mandatory minimum coverage that operators must guarantee to customers.
The 2nd Section of the STJ scheduled for Wednesday of the next week (8) the return of the judgment to determine whether this list should be exhaustive or exemplary.
Therefore, whether plans should be required to cover only what is explicitly provided for in the ANS list or whether they should be required to cover procedures not listed in the listing when necessary, respectively.
The trial began in September last year when the rapporteur, Minister Luis Felipe Salomão, argued that the role of the ANS should be exhaustive.
In this way, the aim would be to preserve the economic balance of the health insurance market, he argued.
In February of this year, the minister Nancy Andrighi defended the thesis that the list of procedures and health events of the ANS has an exemplary nature, that is, it can be expanded to cover more treatments and procedures when necessary.
The trial was suspended after Minister Villas Boas Cueva asked for more time for analysis. According to the Chamber, Minister Nancy Andrighi was invited to participate in the committee’s meeting at the House. However, she did not attend the debate.
Today’s hearing in the Chamber was not attended by representatives of private health plan operators.
According to figures released by the ANS in December last year, Brazil has 48.5 million beneficiaries of health care plans, the highest total since March 2016.
This number represents 25.04% coverage of the Brazilian population.
Federal deputy Flávia Morais (PDT-GO), who chaired the session, said that the commission will carefully monitor the decisions of the Judiciary in relation to the tax role. She said that the collegiate has “a great concern that we lose this flexibility that exists today through the exemplary role”.
In his assessment, the exemplary list allows for a more humanized and even individualized care according to the needs of supplementary health patients, such as people with paralysis, cancer, rare disease or autistic spectrum disorder.
“These are patients, in general, who are in great need of some type of care that, often, in the exhaustive list they will not have, it will be denied to these groups, which are sensitive groups, and need to have this coverage. There’s no other way. They have no way of paying and the only way out will be health plans,” said Morais.
The representative of the Professional Defense Commission of the Brazilian Medical Association (AMB), Florisval Meinão, said that, currently, he believes that the role is considered exhaustive, although people resort to justice to “enforce their rights”.
If the STJ really decides on the exhaustive nature of the list, he said, he considers that patients will have more difficulties in winning legal proceedings for access to medicines and treatments.
Meinão reiterated that doctors are committed to always offering patients the best scientific treatments available and, sometimes, they face difficulties due to the inexistence of certain procedures in the ANS list.
Deputy Flávia Morais agreed with Meinão that, if the STJ decides on the exhaustive nature of the list, it will be even more difficult for patients who tried to access medicines and procedures through Justice. She said that if legalizing a divergence is already difficult today, depending on the decision of the STJ, it may become more impeding.
“What we see here is a totally cruel and perverse logic, because we are putting the profit of health plans above people’s lives. This is very serious”, declared Morais.
A representative of the Rizo Movement Institute – which helps families of children with cerebral palsy -, doctor Francisco Alencar stated that it is already common to come across questions regarding procedures based on the role of the ANS, especially in the area of rehabilitation.
“Sometimes the list of procedures, despite being, in a way, well done, when interpreted by the paying source, is as if it were only for curative situations. Since when can we heal someone [no caso de paralisia cerebral]?”
Alencar said that, on several occasions, therapies defined as standard for certain patients end up being covered only from a lawsuit, which can postpone treatments.
When they are accepted, he said, there are situations where too short periods of therapy are allowed that end up having little practical effect. Therefore, in her view, based on her experience, she argued, the role should be exemplary.
“The list guarantees the prevention, diagnosis, treatment, recovery and rehabilitation” of the diseases provided for in the International Statistical Classification of Diseases and Related Health Problems [CID]highlighted.
The representative of the Rizo Movement Institute also criticized that new therapies take time to be included in the list by the ANS. The commission broadcast a video with testimonies from families with children with cerebral palsy. One of the deponents said that the difficult thing is not being a mother of a child with a disability, but becoming “invisible” to society.
Lawyer for the Special Committee on Health of the OAB do Rio Grande do Sul, Noemi de Freitas stated that a confirmation in the understanding of the role as merely exhaustive may leave out the coverage of measures such as the supply of high-cost medicines, serious heart diseases, videolaparoscopy, hydrotherapy and hippotherapy, he mentioned.
Then, Freitas claimed that the health plan law makes it clear that the list works as a list of basic procedures with exceptions provided. In other words, the role should be treated as a guide, a basic reference, not as an end in itself.
The president of the Commission on the Rights of Persons with Disabilities of the OAB (Ordem dos Advogados do Brasil) of Goiás, Tatiana Takeda, regretted that society had to discuss the classification of the ANS role, and not the quality provided by certain operators of pension plans. health.
“We have to keep in mind that this legislation that regulatory agencies make cannot override constitutional principles. We are talking about human rights. How not to talk about human rights without mentioning the dignity of the human person? This principle is stamped right in Article 1 of our Constitution”, he defended.
The vice president of the social project Angelina Luz, from Rio Grande do Sul, Vanessa Regina Sicchieri Ziotti, also participated in the committee’s hearing in the Chamber, who said she was autistic and the mother of autistic triplets.
She said there is no evidence that health plan operators are about to go bankrupt according to court records so far. In her view, actions aimed at limiting the coverage of the plans “hurt the Federal Constitution to death” by contravening the principle of non-social regression and the rights of people with disabilities, she said.
In an unusual way, the committee’s management allowed people present at the meeting to speak for a few minutes. Most of the statements were given by mothers of children with disabilities.
They asked the ministers of the STJ and Congress for help to ensure broader coverage by health plans. A group should hold a peaceful vigil in front of the court next Tuesday (7), the eve of the date scheduled for the resumption of the trial on the subject.
Source: CNN Brasil
