According to Abramge (association of health plans), the movement is difficult, because, in addition to having capacity in private beds, operators do not even have data on the number of customers who are in the public network.
Marcos Novais, Abramge’s superintendent, says that health plans only receive the information that one of their clients did any procedure at SUS with a year, or more, of delay, when the government sends the bill to the companies. “We don’t know where the beneficiaries are, or if they are and how much. We don’t have these numbers, ”he says.
According to Novais, the entity has been trying to negotiate the issue with the government for at least ten years. He states that the notification should be immediate, as soon as the beneficiary enters the public system, so that the operator could make a private unit available to the patient.
The ANS (National Supplementary Health Agency), however, says that this is not possible. “The reimbursement to SUS considers data on billing related to the use of the public system, which is more complex than a simple identification of the use of SUS by the beneficiary of a health plan”, says the agency.
According to ANS, the health secretariats send the data to the Ministry of Health, which consolidates the information and then makes it available to the agency. Only then are operators notified to pay for services.
Another challenge, according to Abramge, is that private ICU beds are also in a critical occupation situation in Brazil. “We are opening beds. Not at the pace we need, but at the pace that the infrastructure and the number of professionals allows ”. Novais also says that the private network has beds loaned to SUS for at least a year.
ANS says it will analyze the matter in a meeting with the minister.
The entity also says that the beneficiary of a health plan has the right to be removed by its operator from a public unit to an establishment of the accredited network.
“The operator can be activated by the patient or a family member or by the manager of the public hospital. The sooner this communication is made, the faster the removal will be ”, he says.
With Filipe Oliveira, Andressa Motter e Paula Soprana
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