Recently, the National Supplementary Health Agency (ANS) made a series of changes in relation to the health insurance, such as the blocking of some operators and the end of the limit on the number of consultations and sessions in some areas. In addition, the Supreme Court of Justice (STJ) made changes to the understanding of the list of procedures for coverage of health plans. As a result, some doubts arose among the customers of these services, especially about how to consult procedures that the plan covers.
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On June 8, the STJ established that the list of mandatory coverage procedures by the ANS is exhaustive, which requires coverage only of the treatments and events provided for in the list. Therefore, operators are not obliged to pay for any product that is not on the list. Thus, some patients will not be able to start or continue treatment using their health plan. To consult it, the process is very simple and can be done through the ANS portal.
Despite this, some parameters were established so that procedures that are not on the list could be funded, especially in exceptional situations. Thus, in cases of therapies with medical recommendation and technical evidence, they end up becoming mandatory.
How to consult the list of procedures?
- Through ANS portal, choose the service you need to consult between exams, hospitalization, childbirth or dentistry, and click continue;
- Enter the procedure you want to check and click “Ok”;
- Next, you will have access to the list of procedures shown, so select the option you want to consult and press “continue”;
- Finally, you will receive a result if this procedure is mandatory or not covered by your plan.
As it is an exhaustive role, if operators deny one of these events, they can be fined or even have the marketing of their plans suspended. In addition, these health plan companies cannot offer less services than those on the list, but they can add new coverage.