The Superior Court of Justice broke the leg of users of health plans who receive medical care by injunction or claim in court the coverage of procedures denied by their operators. The STJ did this by deciding that plans are not required to pay for treatments that are not on the list drawn up by the National Supplementary Health Agency, ANS. Those who have already obtained an injunction may lose in the judgment on the merits. Those who still fight in the courts will have a harder time getting favorable sentences.
Until now, the jurisprudence prevailed in the Judiciary according to which the ANS list was just an example. Now, it has become taxing. The STJ left a window for exceptions ajar. But the conditions are draconian. It was established that health plans can deny payment for everything that is not on the ANS list. And it will be much harder for patients to get legal help.
The novelty can still be reversed in the Federal Supreme Court. Until then, the more than 48 million Brazilians who pay for health plans and the entities that represent them should take two steps. The first is to take spears to ensure that the ANS list, which contains more than 3,000 procedures and must be updated periodically, reflects the progress of science.
The second attitude is to demand that the board of the National Supplementary Health Agency starts to represent the public interest, not the interests of the center. Established to protect the clientele from the fury of private health operators, the ANS became a shelter for political associates. The agency has been chaired since July last year by Paulo Roberto Vanderlei Filho. He was nominated by a notorious godfather: Deputy Ricardo Barros, Bolsonaro’s leader in the Chamber, former Minister of Health in the Temer government and star of the list of investigated by the Covid-19 CPI. The Senate passed the name on restrictions, as usual.