The new normative resolution of the National Supplementary Health Agency (ANS) that determined the end of the limitation of the number of consultations and sessions with psychologists, speech therapists, occupational therapists and physiotherapists starts to take effect from today (1st) for all regulated health plans , hired after Law 9.656/1998 or adapted to the law, which have outpatient coverage, that is, consultations and exams.
The decision was taken on July 11 at an extraordinary meeting of the agency’s collegiate board.
“With this measure, health plan operators are now required to cover all consultations or sessions with professionals in these four categories that are prescribed by the attending physician for patients with any disease or health condition listed by the World Health Organization (WHO) , such as autism spectrum disorder, cerebral palsy, downschizophrenia”, said the director-president of ANS, Paulo Rebello.
According to Rebello, this year, there were 22 inclusions of procedures, among exams, treatments, and medications, in the list of mandatory procedures of the ANS.
For the coordinator of the Health Program of the Brazilian Institute for Consumer Defense (Idec), Ana Carolina Navarrete, this resolution comes after intense demands from different institutions of patients and consumers who already called attention to the “abusiveness” of limiting the number of queries with these categories.
“Before, this list limited the number of consultations with these professionals to 12 a year. If they needed more, the consumer would pay or go to court, which, in most cases, determined the coverage by the health plan”, said Ana Carolina.
The expert recalls that if the plan denies coverage or imposes any limit on consultations and sessions with the four professional categories, the consumer must first try to resolve it with the operator. “If that doesn’t work, then you should file a complaint with the Procon of your state or municipality or directly with the ANS itself”.