São Paulo – The Supreme Court of Justice (STJ) will decide on Wednesday (23) whether or not health plans may be required to cover diagnoses, procedures and treatments not on a list of minimum coverage set by the national health agency for Complementary Health, ANS. This is the case of examinations such as positron emission tomography, a type of tomography capable of diagnosing cancer and its stage of development, the use of video laparoscopy technology in various surgeries, hydrotherapy and other physiotherapy, correction of myopia above 12 degrees, immunotherapy for the treatment of tumors, So-called ABA (Applied Behavioral Analysis) therapy for children with autism, or even migraine medications, among others are in high demand in basic health plans.
“When you have cancer or a doctor recommends a test or procedure that is not on the ANS list, such as cannabidiol for epilepsy, for example, the solution is to take legal action. In general, the court recognizes that the old list of ANS is a typical list. And it gives A reason for the health plan client,” he said RBA Journalist, writer and activist Andrea Werner, founder of The Caterpillar Institute turns into a BUPA.
STF ministers will continue to rule on the so-called divergence ban, a set of actions taken by clients of health plans that have denied coverage for not being on the ANS list. In them, lawyers defend the thesis that the role is exemplary. In other words, its elements provide an example of what should be guaranteed to customers in terms of health services. The matter is so comprehensive that it has been declared by the court to be of general repercussions.
Health and profit plans
In April 2021, in the midst of the most dangerous period of the covid-19 pandemic, the ANS proved the list to be exhaustive. Thus, health plans are now required to provide only what is on the list. With the change, there was more elimination.
“If they decide on the comprehensive nature of the list, millions of Brazilians will suffer from a health disability. There will be no further possibility of appealing to justice in the event of refusal to cover the agreement,” said the activist, noting that the dispute in question does not cancel the fight in defense of the SUS, because the most affected part is Workers.
Health plans say that if the STF decides the list is typical, it will make Brazil’s private health plans inaccessible to even a larger part of the population. “Unlimited coverage eliminates the predictability of costs, which is critical to contract value, as well as totally inconsistent with the sustainability of a system that seeks to provide greater access to the health of the population,” he wrote in a published article. stadium Natalia Pompeo, Legal Supervisor of the Brazilian Association of Health Plans (AFP).
economic dispute
However, the dispute is purely economic, according to activists of the Lagarta Institute Vera Buba, which is organizing a major event in front of the STF this Wednesday, with the participation of entities from different parts of the country. “In the law there is jurisprudence and the understanding that the good to be protected is life, and that seems self-evident. It is also doctors and families that are best to determine the best treatments, not health plans, that are put in place to offer complementary health to public health.” RBA Attorney Vanessa Ziotti, Legal Director of the Institute.
As he remembers, companies are interfering with treatments to gain gains that can be obtained through other risk management models. They want to offer everything that is cheaper. That’s what we’ve seen with Prevent Senior in the case of a pandemic.”
study ipea It showed that per capita net income from health plans more than doubled from 2014 to 2018. In 2014, total revenue was R$123.8 billion, with growth despite a decline of about 3.3 million in the number of users, which shrank from 50.5 million in the year 2014 to 47.2 million in 2018.
As the 2018 values are updated, it increased from R$ 75.7 in 2014 to R$ 185.8 in 2018. Net income doubled in real terms from R$ 3.825 billion to R$ 8.755 billion.
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