The muffled voice echoes the cry of public servant Diony Souza of Mato Grosso (MT) when he regrets the decision taken by the STJ (High Court of Justice) to allow health plans to be excluded from the coverage of treatments that do not only appear. -List of the ANS (National Supplementary Health Agency).
Adrian’s mother, a 3-year-old with autism, was the mother and father of autistic child Diony, who followed both inside and outside the courtroom. The day before, along with other protesters, he was on a vigil in front of the Court’s headquarters and, until then, had hoped for a positive decision.
With 3 votes against 6, however, Section 2 understood that plans could have a more specific, restrictive role. In practice, operators may reject procedures not anticipated by the ANS. Hope gave way to desolation.
“It’s heartbreaking to see so many families crying today, not knowing what tomorrow will be like. Not knowing if the plan will knock on the door and take care of the house, the baby’s breathing,” he said. UOL.
Sad to say, but it’s death. There are a lot of children who go untreated one day and die from a treatment that is not on the ANS list. ”
Dioni Souza, Adrian’s mother with autism
The verdict was closely followed by civil society organizations, mothers of children with autism and the families of people with disabilities, as well as health officials, and this semester was one of the most serious cases of STJ.
In February, a group of more than a hundred mothers and fathers of children with disabilities were chained to forensic bars against the tax task. Today, part of the group has returned to the scene with banners and posters against the tax role.
During the afternoon, former BBB Gil do Vigor and Juliette, and actress Paolla Oliveira, shared the hashtag #RolTaxativoMata, which has become one of the most talked about topics on Twitter. On Instagram, presenter Marcos Mion, the father of an autistic child, posted a video calling for a mobilization against the taxing role.
According to journalist Andréa Werner, one of the founders of the Instituto Lagarta Vira Pupa and one of the organizers of the event, there are fears that the plans to cover the health plans for children with autism and the mother of the disabled will start working immediately. As planned in the ANS list.
Although it is not binding, that is, it does not force the rest of the courts to follow the same understanding, the decision of the STJ will serve as a reference for the lower courts when dealing with similar cases.
This decision will kill people. It will leave people with disabilities, serious illnesses and rare illnesses unattended. And if you’re confused, the plans will charge people everything they’ve paid for so far. It’s a huge tragedy in this country today and I hope everyone knows it. “
Andréa Werner, journalist and founder of Instituto Lagarta Vira Pupa
After the trial, protesters left the STJ in an atmosphere of insecurity about the next steps. It is possible to take the case to the Federal Supreme Court if one of the constitutional aspects of the matter is questioned. However, there is no time limit for when this should happen.
Attorney Núbia Vieira, who is also the mother of an autistic child, said she was disappointed with the STJ’s outcome of the trial because the court had “always been sensitive” to the case.
“Our children are losing the opportunity to be productive and survive. There are many children with cerebral palsy who will be harmed. They don’t have time to wait for a Supreme Court decision or a law. It’s frustrating,” he said.
Tax, with exceptions
The STJ has today ruled that the role of the ANS is paramount, which means that health plans are not required to pay for treatments that are not on the list established by the agency.
The understanding was followed by 6 ministers: the speaker, Minister Luis Felipe Salomão, Villas Bôas Cueva, Raul Araújo, Marco Buzzi, Marco Aurélio Bellizze and Isabel Gallotti.
Cueva was the first to vote in this Wednesday’s session (8), presenting the exceptions that could be included in the specific list. An example would be the possibility for patients to request a change in their plan contract, to expand coverage and to include a specific treatment.
In cases where there is no substitute for the necessary medical procedure for the patient, the Minister has decided that the treatment may be included in the coverage exceptionally, as long as the ANS has not previously ruled it out, if there is medical evidence of treatment. and if there is a recommendation from national or international body technicians.
Cueva justified his vote that the tax list ensures more legal certainty and avoids major adjustments, as the loss ratio will be more predictable for operators.
“Establishing a mandatory minimum list allows for predictability for basic monthly quota calculations that can sustain sustainable health plans in the medium and long term, as excessive price increases will hamper barriers to contract maintenance, putting pressure on public health user groups. More SUS,” he said.
Operators deny that the changes pushed by the STJ will lead to further reductions in the coverage of procedures and treatments.
What the operators say
In a statement, FenaSaúd (National Federation of Complementary Health), which represents 15 groups of operators, said the plans will continue to cover all diseases listed in the World Organization’s ICD (International Statistical Classification of Diseases and Related Health Problems). Health (WHO), though, has a specific role to play.
“Against published claims, the specific list ensures access to safe treatments, evaluated and recognized by health regulators and organizations by health officials, as is the case worldwide. The list was established based on an in-depth technical analysis and, as a result, It guarantees access to safe treatments that are evaluated and recognized by healthcare professionals, and it will be up to the Executive to oversee and regulate health services, ”said Marcio Vieira Souto Costa, a lawyer at Sergio Bermudes, a member of FenaSaúde.