5 things that can happen to you if you have health insurance

What was already bad got worse after the Superior Court of Justice, the STJ, changed the understanding of the list of procedures listed by the National Supplementary Health Agency, the ANS, for the coverage of the agreements. Now, the possibilities of having medical procedures through the health plan are reduced.

The STJ decided on Wednesday, the 8th, that operators will only be required to bear the procedures listed in the ANS list – it is no longer just used as an example of procedures that the plan should perform and is now considered exhaustive, That is, only what is on that list is valid. The consequences of this for those who are customers of a health plan will be measured in the near future, but can be felt immediately.

After conversations with researchers and professionals who study and discuss supplementary health in Brazil, I list here five things that can happen from now on.

1) More frequent visits to the SUS

In an interview carried out in May with the doctor Lígia Bahia, coordinator of the research and documentation group on Entrepreneurship in Health at the Institute for Studies in Collective Health at UFRJ, she warned that at least 80% of people who had health insurance would have to resort to to SUS at some point. Without judicial support, the demands not met by the plans must end up in the public health system. It is worth remembering that operators already owe the SUS about R$ 2.9 billion for services that they did not perform.

2) More calls denied

If previously the unfounded denials of your health plan to provide care were frequent, this should become even more common, according to lawyer Juliana Kozan, who is part of a research group on health plans and has already assisted several clients in lawsuits. . “The decision of the STJ works as a seal for operators,” she said.

3) Increase in the number of processes

With more negatives, the judicialization of cases will also be greater. An increase in the number of lawsuits against health plan operators was already evident in the justice of São Paulo in the recent survey by the Study Group on Health Plans and Public-Private Interactions of the Faculty of Medicine of USP – it was an increase of almost 240% in 10 years. Coverage denials are the main reason.

4) Fewer decisions favorable to you

Although not decisive for future court decisions, the STJ decision creates relevant jurisprudence. According to attorney Kozan, currently, 90% of cases involving exclusion from coverage are judged in favor of the beneficiaries of the agreement. With the exhaustive role, these people are left without any guarantee.

5) More money coming out of your pocket

What was already expensive is now going to weigh even more on your wallet. In addition to paying for the health plan, beneficiaries may be required to bear the costs of consultations or other private procedures, in the case of urgent care. They may also have to spend on lawyers and procedural costs if they decide to take the matter to court.

About Jenni Smith

She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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