O que é DUT 65 da ANS? Conheça regra de cobertura de medicamento imunobiológico pelo plano de saúde

ANS Directive 65 is the guideline that stipulates that a health plan must pay for intravenous, subcutaneous, or intramuscular immunobiological therapies. However, this rule is often used by health plan operators to refuse treatment, which generates many doubts among beneficiaries. The main allegations are that the medication prescribed for the patient is not covered or that the disease is not within this rule. So, what to do in this case? Does Directive 65 limit the coverage of treatments by health plans? What does the law say? In this video, Elton Fernandes, professor of postgraduate studies in Medical and Hospital Law at USP Ribeirão Preto and a lawyer specializing in lawsuits against health plans, explains everything you need to know about ANS Directive 65. ANS Directive 65 determines that intravenous, intramuscular, or subcutaneous immunobiological therapies have mandatory coverage by health plan operators. However, the rule establishes some requirements for patients to access treatments. Firstly, the ANS (National Supplementary Health Agency) chose some specific diseases and treatments to include in DUT 65 (a specific list of diseases and treatments), contradicting what is established by the Health Plans Law, which states that all diseases listed in the ICD code have mandatory coverage. In other words, there is a clear discrepancy between the law and the ANS rule, which leaves many patients with legally covered diseases without treatment. This is because health insurance companies are limited to covering only what is described in the ANS list. However, in this video, Dr. Elton Fernandes explains that if your disease or medication is not in the rule, but is in accordance with science, the health insurance company must cover the treatment, according to the Health Plans Law (Law 9656/98), since the law is superior to the ANS rule. Therefore, if the health insurance company refuses treatment claiming lack of coverage based on ANS (National Supplementary Health Agency) DUT 65, seek a lawyer specializing in health insurance. This professional can hold an online meeting, analyze your case, and discuss the feasibility of filing a lawsuit, possibly with a request for an injunction to seek immediate treatment. To access the ANS list of procedures and consult ANS DUT 65, you should click on the link below, which will take you to RN 465/2021. Within this rule, look for "Annex II" and enter the name of the medication, treatment, or disease, as shown in the video: https://www.ans.gov.br/component/legi... Learn more about health plan coverage for immunobiological medications on our blog: https://www.eltonfernandes.com.br/med... The information provided here is general and does not replace a case-by-case analysis, with its specific details, by a specialized lawyer, so that you are informed about the possibilities and risks of your case. #roldaans #dut65 #dut65daans #medications #healthplan #healthlawyer #healthplanlawyer #eltonfernandes #healthlaw To learn more about these topics, follow our website and social media: ▷ Website: https://www.eltonfernandes.com.br ▷ Instagram:   / eltonfernandesadvogados   The law firm of Elton Fernandes is registered with the OAB/SP under number 16.616, and specializes in lawsuits against health plans, the SUS (Brazilian Public Health System), Medical and Hospital Law, insurance, etc.