Learn how the STJ decision affects health plan customers

Critics of the taxing role claim that 49 million users are at risk; The ANS list has more than 3,000 procedures, but does not include treatments such as oral chemotherapy and radiotherapy

pressfoto – www.freepik.comRight hand of an unrecognizable female doctor writes in the chart, while the left hand works on the computer
Health plans are no longer required to cover surgeries that are not included in the ANS’ list.

The Second Section of Superior Justice Tribunal (STJ) decided this Wednesday, 8, that the health insurance are not required to cover surgeries that are not included in the National Supplementary Health Agency (ANS). This list is called the List of Health Procedures and Events and details consultations, exams, surgeries, therapies and the transfer of medicines that are included in the mandatory coverage of the plans. Critics of the decision in favor of operators – consumer protection entities, opposition politicians and associations of mothers of children with disabilities – claim that at least 49 million users are at risk (the number was estimated by the Brazilian Institute for Consumer Protection and reverberated on the social networks). Idec also points out that, “in practice, the right to receive a more adequate medication or treatment will be under strong threat”.

The court’s decision alters an understanding that had prevailed for more than two decades in the Brazilian Judiciary. When someone needed treatment outside the ANS list, they resorted to the courts and, invariably, guaranteed reimbursement by the health plan. The list has more than 3,000 procedures and is considered limited by many health experts. It does not include, for example, types of oral chemotherapy and radiotherapy, which are essential for thousands of cancer patients. The ANS also restricts sessions of some therapies for people with disabilities.

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