in Brasília, the Superior Court of Justice (STJ) will resume voting on the role of the National Supplementary Health Agency (ANS). The ministers must decide if the list will be exhaustive or if it remains exemplary. In the current model, even health procedures not provided for by the ANS are covered by health plans, but a medical prescription is required.
However, if the exhaustive list is approved by the STJ, therapies and treatments that are not provided for by the regulatory agency are no longer covered by health plans, even if there is a medical prescription and scientific evidence. In defense, operators claim that broader coverage can cause financial imbalance in the sector.
about the trial
The trial, which will resume tomorrow (Wednesday, 8), began in September 2021 and was suspended in February this year by request for a view – when more time is requested for ministers to study. Until then, the vote is tied at 1 vote to 1. The rapporteur Luiz Felipe Salomão voted in favor of the exhaustive list, while Nancy Andrighi, in favor of the example.
Beneficiaries of health plans, patient associations and consumer protection defend the approval of the exemplary list, a model in which the ANS list is just a minimum reference and other demands are met upon medical request.
For health plans, the ideal scenario would be the approval of the tax model, in which there is no possibility of including therapies or exams not listed by the regulatory agency, an option to reduce the cost with patients. >>> Join the Sechat group on TELEGRAM and get the news first
Health plans are already cutting therapies granted to autistic patients
Due to the impasse caused by the vote, health plans have suspended therapies granted to children with autism, even if guaranteed through injunctions. Therefore, mothers of patients with autism in Salvador (BA) and Natal (RN) protested in recent months. There are also reports of suspension of therapies in the states of São Paulo and Rio de Janeiro. In defense, the operators claim that the role of the ANS does not provide assistance coverage for this type of therapy.
As a result, patients from all over Brazil are already being harmed, especially those diagnosed with autism, who need therapies performed by TAs (therapeutic assistants) so that the patient can have better monitoring and performance in daily activities, both in the home environment, as in school.
Mothers and institutions plan protests
Organized by Instituto Lagarta Vira Pupa, which offers support to families of disabled people, a group of mothers of autistic people promises to demonstrate in front of the STJ tomorrow, during the vote. The Conduct Institute will mobilize social media for a tweet with the #RolTaxativoÉRetrocesso against the Tax Roll of ANS.
Celebrities have also spoken out about the case, such as presenter Marcos Mion, father of Romeo, an autistic young man, who asked on his social networks that ministers not approve the exhaustive list in February this year. According to Mion, if the tax model is approved, the beneficiaries will be “with their hands tied, with no chance to appeal”.