Victória, daughter of Talita Negri, from Santa Catarina, who lives in Tubarão, in the south of Santa Catarina, was born with microcephaly and needs specific pediatric neurorehabilitation treatments, which are not included in the ANS list (National Supplementary Health Agency).
The family is concerned about the decision of the Superior Court of Justice (STJ), which defined, this Wednesday (8), that health plans are not required to cover therapies that are off the list.
- Share this news on WhatsApp
- Share this news on Telegram
Talita obtained, in February 2022, an injunction for the agreement to pay for the 3-year-old girl’s treatments. According to her, however, the health plan has not yet complied with the court order. She fears that, with the new federal decision, the situation will become even more difficult.
“Up to 1 year and 3 months, we performed all therapies in private clinics, which only provided conventional therapies, without satisfactory results. Vic, with more than 1 year, had never been put on its feet”, he said.
THE neurologist doctor the girl then prescribed more specific treatments. According to the mother, microcephaly caused her daughter a series of brain problems, which affect the child’s speech, vision and motor part. Today, the treatment is financed through Instagram campaigns, action among friends and family help.
“The role of the ANS being considered exhaustive will destroy all the struggle of people who need specific treatments. This is not only in our reality as atypical mothers, but many people will be impacted [pela decisão]”, he stated.
- Health plans do not need to cover procedures outside the ANS list, decides STJ
- STJ decides that the list of coverage is exhaustive; understand what must change
The mother suggests that the list is exemplary, with treatments guaranteed by health plans, but that it is flexible to medical indications.
STJ resumes judgment today on the taxing role of ANS
Specialists assess that the list of ANS procedures is basic and does not include important treatments, such as, for example, some types of oral chemotherapy and radiotherapy, drugs recently approved by Anvisa and surgeries with robotic techniques.
According to lawyer Ana Clara Bittencourt, an expert on the subject, the list is outdated. “Updates happen every two years and do not follow the evolution of medicine”, she says.
“When we consider the exhaustive list, it means that operators will have legitimacy to deny coverage and procedures that are not on the ANS list, which can cause great damage to consumers”, he says.
In addition, the ANS limits the number of sessions of some therapies for people with autism and various types of disabilities. Many patients need more sessions than stipulated to achieve results with these therapies and therefore, in the current model, they are able to obtain payment approval by the health plan.
According to the decision of the STJ, health plan operators do not need to cover procedures that are not listed by the National Supplementary Health Agency (ANS).
The decision covers the coverage of exams, therapies, surgeries and supply of medicines, for example.
Six of the nine ministers voting in the Second Section understood that the so-called list of ANS procedures is exhaustive – that is, that the list does not contain only examples, but all coverage obligations for health plans.
The decision of the STJ does not oblige the other instances to have to follow this understanding, but the judgment serves as a guideline for the Justice.
The STJ’s understanding represents a change in the jurisprudence that had been applied by most of the country’s courts, which understood that the list was just an example.
VIDEOS: Most watched g1 SC in the last 7 days
See more state news at g1 SC