December 2, 2022

Consultations for health plans are completed, find out more

According to a new administrative decision by the National Agency for Complementary Health (ANS), there was a determination to end restrictions on the number of sessions and consultations with occupational therapists, psychologists, speech therapists and physical therapists starting in August for all regulated health plans. He was appointed after the enactment of Law No. 9656/1998.

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Understand changes in health plan limits and how it will help clients who need a specific service/credit:jeanedeoliveirafotografia/

End of the period of consultation for health plans

Initially, the decision to remove restrictions on the number of consultations was made with some professionals in July, after an extraordinary meeting of the agency’s board of directors.

With this measure, according to Paolo Rebelo, ANS President Director, health plan operators are obligated to cover all consultations or sessions of professionals in the four categories prescribed for patients with diseases or health conditions listed in the World Health Organization. (Who is the). Among them, we can highlight schizophrenia, autism spectrum disorder, Down syndrome or cerebral palsy, for example.

However, the new definition aims to promote equal rights for users of health plans, as well as standardize the form of guaranteed procedures for these categories of professionals. In this case, it is believed that the procedure would benefit about 49 million Brazilians who use medical insurance for this purpose.

Also, according to Rebello, this year alone there were 22 listings of actions, including medications, exams and treatments, on the agency’s list of commitments.

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win for consumers

For Anna Carolina Navarrete, health program coordinator at the Brazilian Institute of Consumer Protection (Idec), the decision was made after an intense group of different consumer and patient organizations that actually drew attention to the arbitrary limit on the number of consultations offered by the above categories.

According to her, in the past, the list limited the number of consultations with these professionals to only twelve a year. That is, if the patient needed more, he would have to pay or go to court, which, in most cases, decided that the health plan would cover the consumer’s needs.

However, the expert notes that if the plan refuses to cover the necessary procedures or imposes any restrictions on consultations or examinations related to the four categories of professionals, the client should try to resolve the situation, first, with the operator. If, by chance, this is not resolved, he must file a complaint directly with the head of his state or municipality, or seek directly to contact the ANS itself.

In addition to this measure, the agency also issued a rule in June on expanding and covering health plans for people with pervasive developmental disorders, such as autism. That is, any method or method of treatment for similar diseases indicated by the assistant physicians must be covered by the insurance plans.

see also: Can health insurance companies cancel the agreement? Know how to defend yourself