posted on 04/27/2022 21:22 / updated on 04/27/2022 21:23
(credit: Instituto Lagarta Vira Pupa/ Reproduction)
Even after the Superior Court of Justice (STJ) postponed again the judgment of the so-called exhaustive list – which restricts the coverage of procedures carried out by health plans – scheduled for this Wednesday (27), a group of autistic mothers, worried about the possible setback in the treatment of the children, met in front of the court to protest against the measures.
The demonstration was organized by Instituto Lagarta Vira Pupa, a support group for people who have family members with disabilities, and brought together about 50 people, according to Andréa Werner, founder of the non-profit institution.
Carolina Nadaline, lawyer and legal coordinator at Instituto Lagarta Vira Pupa, explains that the demonstration took place with the aim of showing society the importance of the trial that is underway at the STJ, regarding the list of mandatory coverage procedures for health plans. , created by the National Supplementary Health Agency (ANS). If the so-called taxing list is created, health operators will only be able to cover health procedures and events pre-established in the ANS list.
Thus, a number of other tests and procedures that may be considered by the doctor as the best option for a specific disease or condition, cannot be covered, as they are today.
“Since Minister Vilas Boas, who was the one who asked for views the other time in February, has the prerogative to put this subject of the taxing role on the agenda at any time, we organized the demonstration to come here, at the door, against the taxivity of the role Even though the STJ warned yesterday that it was probably not going to be ruled today, we kept the demonstration and we are determined to make a demonstration at the door of the STJ every time there is a session from now on”, explains Andréa Werner.
According to the organizer of the protest, this issue “is very important” and affects all health plan users in Brazil, not only autistic people, but people with rare diseases, cancer, chronic diseases, among other pathologies.
“All will be affected if this role of the ANS is decreed exhaustive. Several important procedures are not on this list. In the past, people could go to court and managed to get the plan to cover it, but if this list is placed as exhaustive by the STJ, if that’s the understanding, it won’t do any good to go to court. So, this will affect thousands of health plan users from all over Brazil”, declares Werner.
understand the case
The ministers judge whether the list of mandatory coverage procedures for health plans, created by the National Supplementary Health Agency (ANS), will continue to be exemplary or will become exhaustive.
In the exemplary interpretation, the list of procedures covered by health plans contains some items, but operators must also attend to others that have the same purposes, if there is clinical justification from the responsible physician. This has caused families to resort to justice for the right to coverage by the plan to be guaranteed.
In the case of exhaustive interpretation, the items described in the list of procedures would be the only ones that could be required from the plans. As a result, the request for equivalent treatments could be denied, with no chance of judicial recognition.
In a hearing that began in February, the trial was tied 1-1, when it was suspended after Minister Ricardo Villas Bôas Cueva asked for a review of the case, that is, requesting more time to analyze the case.
Before the interruption, Justice Nancy Andrighi voted against the creation of the taxing list and, thus, against the rapporteur Luís Felipe Salomão, who was in favor of the taxivity when the trial started, in September 2021. For Salomão, the role would protect the beneficiaries .
For Nancy, the list should be just an example, “serving as an important reference both for operators and professionals and beneficiaries, but never with the generic imposition of the treatment that must be prescribed and covered by health plans for a given disease”.
According to Instituto Lagarta Vira Pupa, the list of threatened therapies is robust and includes: immunotherapy for cancer; morphine pumps for chronic bone and muscle diseases; surgery for fetuses born with marrow outside the spine; applied behavior analysis for autism and paralysis; and sensory integration, for children with autism or cerebral palsy.
Marcos Mion has already spoken about the case
Father of a young autistic, presenter Marcos Mion manifested himself, in February, when the matter returned to the STJ’s agenda, asking the ministers not to approve the exhaustive list.
In a video posted on social media, Mion says that, if the taxing list is approved, health plans will be “obliged to comply with only basic and cheaper treatments”, and beneficiaries will be “with their hands tied, with no chance to to resort”.
“To be simple and direct, depending on the result of this judgment, we will have an increase in denials from health plans, which is extremely revolting and worrying”, said the global.
“As part of the autistic community, I see enormous despair from families who rely on daily treatment. For autism, the treatment has to be constant, because the risk of losing everything that has already evolved is very high, and this change would mean the end of specialized therapies, which is what goes for people with other disabilities”, explained the presenter. . See the video: