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Nearly 2 billion reais due to the unified health system (SUS) have not been pbaded on by health plan operators or are contingent because of the lawsuits filed by the companies. Value refers to the care provided to additional health-care beneficiaries by public health units
Collection is provided by Act No. 9,656 of 1998, which provides that operators must repay the Union whenever one of its beneficiaries uses the SUS for a service provided in the health plan contract
346.27 million reais are suspended due to a court order. The other health care providers did not pay any other 1.28 billion reais and were enrolled in the active debt of the Union, of which about 300 million did not have been paid but have not yet been included in the active debt. [19659002]
According to Fernanda Fernanda (ANS), responsible for the reorganization of ANS SUS, which regulates the health plans and who is responsible for calculating and collecting these repayments.
Freire of Araújo, many companies are betting on the judiciarization of the process to avoid payment, since the Federal Supreme Court (STF) has not yet decided whether the compensation was constitutional or not. Only in February of this year, the STF decided that the collection is legal and can be done by ANS.
"Until the decision of the STF, we still had an uncertainty, whether it is constitutional or not, they [as operadoras] were right in the invalidity of this collection , then many are betting on the judiciarization because it judiciarizes, deposits the money and
According to the director, the money deposited in court will not be immediately refunded to the SUS, because the shares are distributed in the courts of justice throughout the country and this charge can take up to two years.In addition, all the money filed in court does not refer to the question of the constitutionality of compensation. for example, the amount billed by ANS for certain medical procedures provided by SUS.
The STF's decision will also help, according to Fernanda, in collecting the amount that is recorded in the active debt. she, the refund is a m oyen not only to recover the money spent by the state in the medical procedure, but also to protect the beneficiary of health insurance.
"The refund is a protection for the operator does not stop building up network and does not expel everyone for the SUS.C is to ensure that the recipient "
However, all charges are no longer paid or contested in court." Since 2013, health plans have already repaid SUS $ 2.06 billion.
In response, the National Federation of Supplementary Health (Fenasaúde), which represents the main operators of public health insurance schemes, is responsible for providing funds to the National Health Fund for distribution among the Member States. and the municipalities providing badistance to the beneficiary, the country's health authorities, have indicated that companies resort to the courts when they consider that collection is undue (for example, in the case of procedures excluded by law, in outside geographic scope of the plan or during a grace period) and when ANS does not agree to cancel the charge.
In Fenasaúde's view, it is necessary to strengthen the integration and agility of information between the public and private systems. "When a beneficiary of a health plan is served by the public network – as in road accidents – the operator must be informed as quickly as possible in order to promote the transfer to the public. private network, provided that injury to the recipient Operators or beneficiaries have no interest in using the public health network.Operators provide the supply and guarantee of services contracted with their beneficiaries, "explains Fenasaúde
Source http://agenciabrasil.ebc.com.br/geral/noticia/2018-07/sus-tem-but-de-r-bilhoes-receber-das-operadoras-de-planos-de 19659022) (function (d, s, id) {
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