The operators of the well being plan need to change within the Senate the invoice accepted final Wednesday (3), by the Chamber, which requires corporations to cowl applications that aren’t a part of the Nationwide Supplementary Well being Company (ANS).
The proposal should be analyzed by the senators subsequent week – whether it is modified, the textual content returns to be analyzed by the deputies. The sector additionally fears elevated prices for patrons by means of the venture.
The venture determines that plans do procedures outdoors the checklist of ANS if there may be proof of effectiveness “based mostly on scientific proof and remedy plan”; there are suggestions from the United Well being System (SUS); or there’s a suggestion from a single well being skilled analysis physique (such because the US FDA).
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The priority of the business is to keep away from utilizing solely “scientific proof” to justify the protection of sure remedies, because it acknowledges that the assertion shouldn’t be clear.
“We’re not towards the invoice, however we’re involved about this distinctive method, which can permit remedy that isn’t obtainable wherever on this planet”, defined the president of the Brazilian Affiliation of Well being Insurance coverage Firms, Renato Casarotti.
He defends including the necessity for scientific proof to the necessity for approval from an internationally acknowledged company.
Mainly, the venture reverses the June determination of the Supreme Courtroom of Justice (STJ) which established the total nature of the ANS’s checklist of applications. Consequently, corporations not need to pay for remedy that isn’t supplied on the checklist, amongst different issues.
The checklist of ANS is an inventory of three,368 well being occasions, together with consultations, examinations, remedies and surgical procedures, along with drugs and orthoses / prostheses related to these procedures.
Casarotti stated, if the venture is accepted by the Senate and turns into legislation, all plans, particular person, household and group, can be very costly. It’s because, within the absence of predictability, there can be a necessity for “value insecurity”, he says.
For José Luiz Toro da Silva, accomplice at Toro Advogados & Associados and president of the Brazilian Institute of Well being Legislation, the methods concerned can be particular person and group.
“With the venture, there is no such thing as a approach to estimate or know prematurely how a lot can be charged subsequent yr. It’s unattainable to know the best way to repair it once more, as a result of there may be nothing predictable,” he added.
In an article, the Nationwide Federation of Supplementary Well being (FenaSaúde) emphasised that any change within the legal guidelines should shield affected person security, based mostly on proof of the effectiveness of medical procedures. “On this regard, it’s essential to take care of a Well being Expertise Assessment course of, which considers the efficiency and value of latest installations”, he says.
Karla Guerra, the authorized coordinator of Aduseps (an affiliation of plan customers), stated that there are various forms of procedures which can be normally denied based mostly on the function of the ANS and are solely approved in courtroom. He cited two instances as examples: one involving the masking of a penile implant and, in a single case, most cancers surgical procedure. Payments like these could be approved based mostly on laws being debated in Congress.
For Ana Carolina Navarrete, coordinator of the Well being Program of the Brazilian Institute for Client Safety (Idec), the textual content brings again the concepts of masking examinations or well being remedies.
“The choice of the STJ didn’t produce pacification on this matter. In reality, it created a really massive public drawback that should be solved by the Congress and the STF,” he says.
Based on consultants, the choice of the STJ prevented the remedy of plan customers with a number of sclerosis, genetic syndromes and psychic syndromes and autistic spectrum issues, for instance, stopping entry to drugs, house care, and residential oxygen provide.
Administrative assistant Érika Soares, 40, underwent surgical procedure to take away a malignant tumor. Now, to begin most cancers remedy with chemotherapy, you could do a check generally known as an animal scan, which detects most cancers cells in several elements of the physique.
This system was rejected twice by the well being plan operator. He sought justice, however the examination, which value greater than R5 thousand, was rejected based mostly on the choice of the STJ.
“The physician would not have requested for this check if it wasn’t essential. I am determined, as a result of the remedy has been disabled for a month”, stated the affected person.
The particular attorneys defined that, for the reason that determination of the STJ, there was a rise within the denial of protection. “If the venture is accepted, the denial of remedy will lose its impact”, says Rafael Robba, lawyer answerable for Well being Legislation within the workplace of Vilhena in Silva.