National Supplementary Health Agency recognizes immediate and mandatory coverage by the List of Procedures and Health Events of the new procedure, US – Endometriosis Research (40901858). Click here and read the letter in full.
The Brazilian College of Radiology and Image Diagnosis (CBR), active in the professional defense of radiologists and committed to the dissemination of clear information to the population, sent a letter to DIPRO (Directorate of Norms and Qualification of Products) and to DIDES (Directorate of Sectoral Development) of the National Supplementary Health Agency on October 21 about some complaints received regarding denials of coverage of such procedures by health operators, which also deny knowledge about the obligation of coverage.
In the letter, the CBR also requested speed in the inclusion of the procedure in the TUSS.
The ANS responded to the CBR's request by means of an official letter, informing that “private health care plan operators are obliged to offer all the procedures provided for in the current List of Procedures and Health Events, in order to fully meet the coverage provided for in articles 10, 10-A and 12, of Law No. 9656/1998 , according to the care segmentation, geographic area of coverage and area of operation of the product within the maximum service deadlines provided for in Normative Resolution (RN) No. 259/2011”.
In this way, it also emphasizes that “ANS establishes the List of Health Procedures and Events, currently in force through RN nº 428/2017, which constitutes the minimum mandatory coverage to be guaranteed by health plans marketed from 1/2/1999, as well as for those hired previously, as long as they are adapted to Law No. 9656/1998, pursuant to art. 35 of said Law, respecting the contracted assistance segmentations. It should be noted that RN nº 428/2017 came into force on January 2, 2018”.
It is worth remembering that the CBR published, on September 30, through its Economic Advisory, a complete and detailed text on the new procedure for investigating endometriosis via ultrasound included in the CBHPM and in the ANS mandatory coverage list.