During cancer treatment, concerns may arise about financial and practical issues linked to curing the disease itself. We are talking about factors such as being able to pay for all the medicines, dealing with the bureaucratic part of health plans and being able to attend consultations and treatment sessions (such as chemotherapy or radiotherapy), even if they need to be carried out in places of difficult access for the patient.
Article 196 of the Federal Constitution declares: “Health is a right of all and a duty of the State, guaranteed through social and economic policies aimed at reducing the risk of disease and other aggravations and at universal and equal access to actions and services for its promotion, protection and recovery”. Thus, Brazilian legislation ensures benefits that facilitate the patient’s journey. They can be municipal, state or federal.
Find out below those directly related to health and how they can be accessed.
SUS (Unified Health System)
Before anything else, it is important to keep in mind that every Brazilian is entitled to the SUS (Sistema Único de Saúde), a free public service that covers all types of care, from outpatient care to organ transplantation, including surgeries, and access to medicines.
To access the SUS, it is necessary to obtain the SUS Card at a UBS (Basic Health Unit), upon presentation of an identification document with a photo, such as the RG and also your proof of residence. In just a few minutes the sheet with your “card” will be printed and you will be part of those registered in the system. Due to the high demand for SUS services, there is usually a longer waiting time for treatment. This is an aggravating factor for cancer patients, who need quick diagnosis and scheduling of all the procedures necessary to treat cancer. To ensure that there is no harm to the health of these patients, there are two specific laws:
30-day law – determines that, in case of suspicion of cancer, tests to confirm the diagnosis must be performed within 30 days (Law No. 12,732/2012, art. 2, §3)–. It encompasses a wide range of exams, such as radiographs, ultrasounds, computed tomography, magnetic resonance, upper digestive endoscopy, colonoscopy, hysteroscopy and anatomopathological; and
Law of 60 days – determines that, with the pathological report (diagnosis) signed in hand, the cancer patient has access to the beginning of treatment in a maximum of 60 days, thus aiming to prevent the advancement of the disease (Law nº 12.732/2012, article 2).
If these laws are not complied with, the patient must contact the ombudsman of the health unit where he was treated. If this is not possible, you must contact the SUS ombudsman directly, on the phone 136 (from Monday to Friday, from 7 am to 10 pm; on Saturdays and Sundays, from 8 am to 6 pm; and not available on holidays).
Breast reconstruction surgery
Another free and unrestricted service offered by the SUS is breast reconstruction plastic surgery for patients who have had their breast completely or partially removed for the treatment of cancer. It can be requested at the same treatment location or at any UBS, which will forward the request to a specialized unit. If the patient has a health insurance plan and prefers or needs to undergo the procedure through it, coverage is mandatory and is provided for in article 10-A of Law No. 9,656/1998.
Health insurance
Private health plans are services offered by private operators or companies so that people have private medical, hospital and outpatient care, outside the SUS network, upon payment of monthly fees. They are subject to the rules of Law No. 9,656/98 and the Consumer Defense Code.
The law provides that no person can be prevented from contracting a health plan, regardless of their general health conditions, as long as they meet the requirements established in the contract:
- 24 hours for urgencies and emergencies;
- 300 days for full-term delivery (gestation over 37 weeks);
- 180 days for consultations, exams, hospitalizations and surgeries; and
- 24 months for preexisting conditions.
When a person switches from a health plan to another in the same price range and the shortages have already been met in the previous one, there are no new shortages. However, if the change includes a change in the health plan category, whether with the same operator or another, shortages may be stipulated in relation to professionals, entities and/or health care services (including accommodations for hospitalizations) that were not part from the previous plane.
In the case of cancer patients who purchase a health plan when they are already aware of the disease, the grace period of 24 months must be fulfilled for surgical and highly complex procedures, and for high-tech beds related only to the declared pre-existing condition. This means that these same procedures and beds must be covered if their need is not related to pre-existing cancer (respecting the other grace periods).
After these 24 months, patients will have full coverage of the contracted health plan. To avoid the need to comply with grace periods, some operators work with a monthly fee – a temporary increase in the monthly fee of the customer who declares to have pre-existing diseases or injuries -, which is freely negotiated between the parties and must include in the contract. It is essential to provide all information about pre-existing illnesses or injuries in the health declaration completed for the operator. Omitting them can be considered fraud and lead to the suspension or termination of the contract. If the operator takes the case to the ANS (National Supplementary Health Agency) and the fraud is confirmed, the patient may be required to reimburse all expenses incurred with the pre-existing condition.
Free medicines
The SUS guarantees everyone access to free pharmaceutical care, which includes medicines used in the treatment of cancer. They are requested by the doctor who is conducting the treatment and removed by the patient at the indicated place.
If the medication is not available or is not sent to the indicated place, contact the SUS ombudsman, on the phone 136 (from Monday to Friday, from 7 am to 10 pm; on Saturdays and Sundays, from 8 am to 6 pm ; and not available on holidays).
Out-of-home treatment
Ordinance SAS No. 55/1999 guarantees cancer patients access to health services in other municipalities and, in special cases, in other states, when all means of treatment in the municipality are exhausted. It is the TFD (Treatment outside the home), which provides transport, food and, if necessary, accommodation exclusively for people treated in the public and referenced network. When there is a medical indication, the benefit can be extended to a companion.
The distance must be greater than 50 km from the patient’s home, and coverage values are established by the municipalities according to a standard federal table.
