Clipping of news on Brazilian Culture, Law and Citizenship
19/03/2013
This article was translated by an automatic translation system, and was therefore not reviewed by people.
Cochlear implant is indicated for the disabled who do not improve with ordinary hearing aid
BRASILIA - A decision of the Federal Court of Sao Paulo, announced last week strengthens the warranty coverage of the implant called the "bionic ear" on the part of health plans - including expenses related to the procedure. Moreover, the decision reinforces that plans are required to perform cochlear implants in both ears for deaf patients of all ages who have an indication for the procedure.
Health plans are required to bear all costs for the cochlear implant, which may be indicated for the deaf who can not hear using the traditional devices. However, despite the rule of National Health Agency (ANS) that requires the coverage, patients still need to go to court to get the plan pays the procedure, and complain that pre operative examinations, equipment maintenance and subsequent treatments are not covered .
- The agreements cover doctor visits, but no consultations with psychologists and speech therapists. Cover exams, surgery, hospitalization and apparatus. Then some cover auditory rehabilitation therapy with speech therapists, but do not cover activation, mapping, spare parts and maintenance. And not all covenants pay smoothly. There are those who simply find a loophole in the contract and deny until the person go to court. Others cover only the surgery, but the medical fees. Have you heard of covenants which refused to pay the unit itself - Lakshmi said Lobato, who received implants in both ears as an adult and has a blog on the subject (http://desculpenaoouvi.laklobato.com/).
According to the regional prosecutor of civil rights, Jefferson Aparecido Dias, who directed the action, the decision pacifies the matter before the courts, and ends with the possibility of rule changes made through acts of ANS.
- The action is not against the plans, but against the NSA. The plan is required to comply, and if they do not comply, it is for the NSA to monitor and punish - Dias said.
Surgery also SUS
Although the decision concern only the obligation of private health plans pay the cost of the implant in both ears and for any age, the decision will also serve to support requests for bilateral surgery by SUS, which does not perform the surgery on both ears. The attorney advises that patients entering the SUS Justice based on this decision to achieve bilateral implantation.
Another change is that the decision also brings determine which health plans will have to pay for the maintenance of the equipment, which is still cloudy and concerned patients already operated, they complain about the difficulty in obtaining parts and make repairs to equipment. To the prosecutor, is implicit in the new rule that if the health plan is required to fund the operation and equipment, you must keep it.
According to Sandra Giorgi Sant'Anna, MSc for medical school and a member of the USP CER Speech Therapy, which treats patients implanted, the part of speech not covered by many plans, and this is a part of the treatment that should be made to the lifetime of the deployed. The equipment maintenance is not covered. The device comes out of warranty after three years installed and parts are very expensive. Sandra exemplifies a wire that costs about R$ 600, a microphone sells for R$ 3 to R$ 5 thousand. And if you need to replace the main part of the implant, the processor, you need to spend about $ 20 thousand.
- Maintenance of the processor in the covenant never even seen someone try - says Sandra.
Other costs related
Richard Benedict, center coordinator cochlear implant, Hospital das Clinicas in Sao Paulo says that despite the standards for plans, in some cases patients have to go to court to get the surgery. Mariana Candal, Joana's mother, who is now 1 year and nine months and was bi-deployed at seven months, also said that hears many reports of difficulties coverage plans. For the operation of his daughter, who was covered by the plan, she had to bear the costs of pre operative exams.
- The resonance mastoid is not mandatory procedure by ANS, and then the difficulties begin. We had to pay in 2011, more than R$ 500 reais. For many people the process is already feasible at this point. Everything is very expensive - said. According to Mariana, some plans, especially smaller ones, usually bureaucratize the process, with a request to give reports a "weariness" on who is asking.
The NSA confirms that provides for additional costs related to the surgery should be covered by the plan, including previous examinations and subsequent maintenance. The agency said the ruling does not change internal rules that already have mandatory.
However, according to the regional prosecutor Jefferson Dias, the decision to exclude the possibility that health plans may call the bond, which gives more assurance that the patient is entitled to cover the procedure. Moreover, the agency says it will not appeal the decision in court. If you have problems with the health plan, the agency indicates that patients seek the Dial ANS (0800 701 9656), Portal ANS (http://www.ans.gov.br/).
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This article was translated by an automatic translation system, and was therefore not reviewed by people.