The Federal Senate approved, this Monday (29), the bill that prevents the limitation of coverage of treatments by health plans regardless of being on the list of procedures of the National Health Agency (ANS). After a symbolic vote, the text goes to presidential sanction or veto.
This list served as a parameter of what should be offered by operators and agreements and left open the granting of treatments and medicines not listed, which often ended up being decided in court.
The project’s rapporteur, Senator Romário (PL/RJ), maintained the text approved by the Chamber of Deputies and justified that the most important thing about the proposal is that even with the prescription of treatment by the doctor or dentist, this must meet the minimum requirements not to harm the health of patients.
“Even if it is not included in the list of procedures defined by the ANS, it must be covered by the health operator if it meets at least one of the following requirements: it must be proven effective, according to scientific evidence and the therapeutic plan; or be recommended by the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec) or by another internationally renowned health technology assessment body,” he said in the document.
The senator also explained in the report that this legal provision aims to pacify the understanding of the coverage scope to be guaranteed by health operators, who would be obliged to pay for necessary treatments for the patient even if they are not listed in the List of Procedures and ANS Health Events.
The bill approved in the Senate overturns the decision of the Superior Court of Justice (STJ), as it amends the Health Plans Law and provides consumers with more than one opportunity to prove the need for treatment, provided that it has a scientific basis or has been approved by agencies of international health.
In the understanding of the STJ ministers, the imposed requirements should be cumulative and the treatment should only be released if there is no other alternative for the beneficiary. And yet, the determination did not leave room for other interpretations — which, according to health plan users, limited access to exams, medications, treatments and hospitals.
Specialists estimate that the refusal of treatments by health plans due to the taxing role, especially the more expensive and complex ones, will have to be absorbed by the Unified Health System – SUS, which can generate an even greater burden on the cost of public health.
For lawyer Rafael Robba, a specialist in the right to health, consumers will not ask for any type of treatment. “The PL requirements are very clear. Requests for experimental treatments or procedures with purely aesthetic purposes, for example, do not find shelter in the Judiciary,” he said.
Source: CNN Brasil
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