mothers of autistic children regret decision on ANS role

The choked voice holds back the cry of public servant Diony Souza, from Mato Grosso (MT), when she regrets the decision of the STJ (Superior Court of Justice) that allowed health plans to reject coverage of treatments that are not listed in the so-called list of ANS (National Supplementary Health Agency).

Mother of Adrian, 3, who has autism, Diony was one of the mothers and fathers of autistic children who followed the trial from both inside and outside the courtroom. The night before, she had attended a vigil in front of the Court’s headquarters with other protesters and, until then, had hoped for a positive decision.

By 6 votes to 3, however, the 2nd Section understood that the plans can follow an exhaustive, more restrictive role. In practice, operators can deny procedures that are not provided for by the ANS. Hope gave way to desolation.

“It is heartbreaking that so many families are crying today, not knowing what it will be like tomorrow. Not knowing if the plan will knock on the door and take home care, the child’s respirator”, he told the UOL.

Sad to say, but it’s death. There are many children who, if they go a day without treatment, and a treatment that is not on the ANS list, dies”
Diony Souza, mother of Adrian, who has autism

The judgment has been closely followed by civil organizations, mothers of autistic children and families of people with disabilities, as well as by health care providers, and was one of the most pressing cases in the STJ this semester.

In February, a group of more than one hundred mothers and fathers of children with disabilities chained themselves to the bars of the court against the taxing role. Today, part of the group returned to the place with banners and posters against the taxing role.

During the afternoon, celebrities such as former BBBs Gil do Vigor and Juliette, as well as actress Paolla Oliveira shared the tag #RolTaxativoMata, which became one of the most talked about topics on Twitter. On Instagram, presenter Marcos Mion, father of an autistic child, released a video asking for mobilization against the taxing role.

For journalist Andréa Werner, founder of Instituto Lagarta Vira Pupa and one of the organizers of the act, there is a fear among mothers of autistic and disabled children that health plans will start working immediately to overturn decisions that were previously favorable to coverage of procedures not provided for in the ANS list.

Although it is not binding, that is, it does not oblige the other courts to follow the same understanding, the STJ’s decision will serve as a reference for lower courts when dealing with similar cases.

This decision will kill people. It will leave people with disabilities, serious illnesses and rare diseases unattended. And if you mess up, the plans will charge people for everything they’ve paid so far. It’s a giant tragedy that has befallen this country today and I hope everyone is well aware of that.”
Andréa Werner, journalist and founder of Instituto Lagarta Vira Pupa

After the trial, the protesters left the STJ with a climate of insecurity about the next steps. There is the possibility of the case being taken to the Federal Supreme Court, provided that some constitutional aspect on the subject is questioned. There is, however, no time limit for when this should occur.

Lawyer Núbia Vieira, who is also the mother of an autistic child, said that she leaves the STJ disappointed with the outcome of the trial, since the court “always was sensitive” to the cause.

“Our children are losing the chance to be productive and even survive. There are many children with cerebral palsy who are going to be harmed. They don’t have time to wait for a Supreme Court decision or a law to help them. It’s desperate,” he said.

Tax, with exceptions

The STJ decided today that the role of the ANS is exhaustive, that is, health plans are not required to pay for treatments that are not on the list set by the agency.

The understanding was followed by 6 ministers: the rapporteur, minister Luis Felipe Salomão, ministers Villas Bôas Cueva, Raul Araújo, Marco Buzzi, Marco Aurélio Bellizze and minister Isabel Gallotti.

Cueva was the first to vote in this Wednesday’s session (8) and presented exceptions that could be included within the exhaustive list. An example would be the possibility of the patient asking for an amendment to the plan’s contract to expand coverage and include a specific treatment.

In cases where there is no substitute for the medical procedure necessary for the patient, the minister decided that the treatment may be included in the coverage exceptionally, provided that it has not been previously rejected by the ANS, if there is medical proof of the treatment and if there is a recommendation from organs national or international technicians.

Cueva justified his vote by stating that the taxing list guarantees more legal certainty and avoids large readjustments, since the loss ratio will be more predictable for operators

“The establishment of a mandatory minimum list allows predictability for calculations that support monthly fees capable of maintaining sustainable health plans in the medium and long term, as the exaggerated price increase will cause barriers to contractual maintenance, transferring public health users’ collectivities to pressure even more the SUS”, he said.

The operators deny that the change promoted by the STJ will lead to more restrictions on coverage of procedures and treatments.

What operators say

In a statement, FenaSaúde (National Federation of Supplementary Health), which represents 15 groups of operators, said that the plans will continue to cover all diseases listed in the ICD (International Statistical Classification of Diseases and Related Health Problems), of the World Organization. of Health (WHO), even with the exhaustive role.

“Contrary to publicized claims, in fact, the exhaustive list guarantees access to safe treatments, evaluated and recognized by regulators and bodies responsible for health care, similar to what happens around the world. The list was established based on in-depth technical study, and it will be up to the Executive Branch to supervise and regulate health services”, said lawyer Marcio Vieira Souto Costa, partner at the Sergio Bermudes office, which represents FenaSaúde.

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She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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