An extraordinary meeting on July 11th approved the end of limiting the number of consultations with four professional categories by the ANS (National Supplementary Health Agency).
Are they: physiotherapy, speech therapy, psychology, occupational therapy.
And this new rule comes into force this August.
To help you understand this change and also prepare your health plan provider for the consequences, the Blog SAUDI team prepared this article. Check out!
Understand the reasons and what changes in the law
Before we talk about what changes and how this change impacts your operator, it is necessary to understand the main argument that supported this change.
The ANS states that the main objective of this release of the number of consultations and sessions was to promote equal rights for users of supplementary healthcare.
This is because, with the exclusion of the Use Guidelines, which are conditions required for certain coverage, for procedures with these categories of professionals, the service starts considering the prescription of the doctor involved.
Access to therapies for users who need them tends to become less bureaucratized and easier to access.
Furthermore, the ANS highlighted that as it comes into force on August 1st, it is valid for users who have any disease or health condition listed by the World Health Organization.
Among them, it is possible to mention conditions such as schizophrenia, Down syndrome and cerebral palsy.
Impacts on plan costs: will there be any changes?
One of the main questions that managers of supplementary health providers are asking themselves is how much these changes will impact their health plan costs.
According to a survey carried out, this decision impacts between 2 and 4 million people, especially those who have longer-lasting disorders such as autism, Down syndrome, Parkinson's and more complex psychological disorders.
Despite this number, for Leonardo Quadros, president of APCEF/SP, this application of the new rules should not generate a significant impact on the plan's total costs.
He emphasizes that the current limit of sessions in these categories already meets the needs of the vast majority of plan users, which is why it may not generate a significant increase in the costs or sustainability of the plan.
On the other hand, with the release of the number of consultations, users who need more sessions than allowed, the benefit generated is great since the medical prescription will consider the person's needs and not the restrictions imposed by the plan.
Adopt a medical audit system that reduces costs
With the mandatory end of limiting sessions for the four categories we mentioned, psychologists, speech therapists, occupational therapists and physiotherapists, operators have been needing to adapt since the beginning of August.
The impacts on costs will only be understood when the number of procedures actually increases over time.
However, you don't need to wait for costs to increase and then worry about reducing them when there is a system of medical bill audit ready to be used by your health plan operator.
A solution that dozens of operators in Brazil already use is SAUDI, as it has a thorough audit tool that puts put an end to possible undue payments to the network of medical service providers and optimizes your operator's entire process, resulting in a significant reduction in operational costs.
Another relevant point is that the system SAUDI can be implemented in a truly short time frame, with simple and intuitive use, enabling your team to master our solution quickly.
Get in touchtact with us, get to know SAUDI and we will prepare your healthcare provider for this change in the rules of the supplementary healthcare sector.
