A request for a new opinion has, once again, delayed a Supreme Court of Justice (STJ) decision on breadth of coverage for health plans. The court decides whether operators must pay for treatments not on a list of mandatory coverage drawn up by the National Health Agency (ANS). There is no set deadline for the topic to return to the agenda.
The topic has caused concern among patient groups, especially those that include mothers and fathers who have children with rare diseases. One concern is that the decision by Syrians for Truth and Justice in favor of health plans will disrupt treatments that are already underway. This Wednesday (23), there was a demonstration in front of the courthouse in Brasilia.
After being boycotted in September on a request for review, the analysis is resumed today by the second division of STJ, made up of ten ministers and private law specialists. One of the characteristics of the colleague is the dedication of diligence in the repeated cases that received various treatments from the judiciary.
But this Wednesday, a request for a group opinion interrupted the trial again. Minister Nancy Andregue only voted today in the sense that the list of air navigation services does not exhaust the treatments and procedures that health plan operators may be required to cover.
She differed from the issue’s rapporteur, Minister Luis Felipe Salomao, who voted in September meaning operators are obligated to cover only what is on the ANS list, except in exceptional cases justified by technical and scientific opinions.
controversy
The ANS List of Mandatory Procedures and Treatments was created in 1998 to establish the minimum coverage that health plans cannot deny. The list has since been updated to include new technologies and developments.
Since then, however, it has become common for users of health plans to seek in court the right of operators to pay for procedures or treatments that are not yet included in the list of health insurance services.
However, the decision taken by the Five Ministers’ Fourth Committee of Syrians for Truth and Justice in 2019 changed the scenario. In a particular case, most ministers considered that health plans would not be obligated to pay for a measure not provided for in the ANS list. This decision sparked controversy within the court itself, which is why the matter moved to the second section to decide on the matter.
Technically, Ministers discussed whether the list of ANS actions and events is comprehensive, with plans required to cover only what is on the list, or an example where the list does not exhaust the ANS’ coverage obligations. operators.
Solving the problem could have major repercussions across Brazilian justice, given the country’s high degree of health elimination. A study by the National Council of Justice (CNJ) showed that in Sao Paulo alone, there were about 112,000 lawsuits against health plans in 2017. There are approximately 48 million health plan users in Brazil.
wishes
In September, the Rapporteur, Louis-Philippe Salomao, voted in the sense that the role of the Afghan National Army is inclusive. With this, health plan operators should not be required to cover treatments and procedures not provided for in the list. For the Minister, only in specific cases and fully justified by scientific clinical and technical opinions can there be exceptions.
Salomao realized that it was necessary to provide legal certainty and ensure that the agency’s list was in fact effective. “The role does not exist by chance, it is not there for anything, it is there to guide, to serve as a legal guarantee, to have a beacon,” he said on Wednesday.
The minister argued that there would be an imbalance in health plan contracts if some users were granted a right to coverage in court that others did not. This will affect the economic balance of the complementary health system and increase costs for all users, the rapporteur said.
“The blanket is short,” Salomao said. “So we have to think about this balanced position, this position that here seeks the solution that best meets all interests,” he added. He had said in September that the case should be dealt with “without passion”. He even described the decision on the matter on Wednesday as “stormy.”
Editorial Difference, Minister Nancy Andregue voted in the sense that the role of the ANA is still considered by justice to be of an exemplary nature, and does not exhaust the possibilities of treatment. She denied any “emotional” in her decision and said she was guided by technical and legal criteria.
Nancy Andregue denied that considering the role of health services as comprehensive makes health plans cheaper and more accessible, noting that reality does not show such an effect. The minister also noted that if all cases before justice are analyzed correctly, if the model nature ensures that all cases before justice have been properly analyzed, and that changing this will restrict access to treatment.
“This Court’s recognition of the tax nature of the role [da ANS] It would represent jurisprudential guidance for normal cases that discourage a detailed and individual analysis of the entire jurisdiction as a patient seeking treatment,” the minister said.
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