“These ministers don’t know what it’s like to go to the SUS queue at dawn,” says the mother of a child with microcephaly and autism about STJ’s decision | Pernambuco

6-year-old Guilherme’s mother, who suffers from microcephaly and autism spectrum disorder, 31-year-old Germana Soares, received a phone call from her health plan on Wednesday as the Supreme Court (STJ) followed her home vote (8) and was overwhelmed. The court ruled that operators should not cover procedures outside the list of the National Supplementary Health Agency (ANS) (see video above).

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On the other hand, the health plan worker stated that she would check to see if she was on the TheraSuit ANS list of intensive care required for her son. Very shaken, he said the feeling about the decision was impotence and rebellion.

Six out of nine ministers in the Second Division voted to define the ANS list as having all the required coverage. Decisions affect examinations, therapies, surgeries, and the supply of medicines, for example.

“The poor born in Brazil is doomed. We live in a country where money speaks louder than life. These ministers don’t know what it’s like to be in line for a SUS. [Sistema Único de Saúde] At dawn, wait for months, ”said Germany.

Germana Soares followed the STJ vote from home – Photo: Reproduction / WhatsApp

Germana Soares knew her son’s diagnosis as soon as he was born. At the age of 20, Guilherme was undergoing all possible treatments. Through her health plan for her father’s work, she also made TheraSuit, which is effective in treating motor disorders.

Today, with another health plan, she asked for treatment again. The response came after the session and left her more emotionally shaken. She was crying when she answered the call on the g1 report.

Guilherme performs therasuit treatment, if motor stimulation – Photo: Reproduction / WhatsApp

German said she was a real estate agent, but left her job to devote herself entirely to her son.

“My job, my marriage, I left everything to his advantage. I saw the dawn of the day in front of the clinic. I can’t understand that the treatment will be denied and a lot of people will die. I’m torn. My heart is broken,” he said.

The mother of twins Ângelo and Pedro, 14, who are part of the autism spectrum of Polly Fitipaldi, said she had high blood pressure after this Wednesday’s vote.

“I kept going and I feel sick here. Anyway, it was very stressful for us. We really wanted to be a role model because our lives would continue to be difficult, but not so difficult, ”he said.

Polly Fittipaldi with her children Ângelo Rafael and Pedro Augusto – Photo: Courtesy

The mother’s main concern is what the future of the child will be without proper treatment. “I’m grieving. Frustrated, worried. If I wasn’t sure about my child’s future at first, now I have to wait to pull my process and say they’re canceling treatments,” she said.

There is concern that health plans could overturn court orders for families to have access to specialized treatment for their children. According to Polly Fitipaldi, it is very difficult to find the right treatment.

“And nowhere in Pernambuco is there any proper treatment for autism in the SUS. Only 15 cities have a device that provides treatment, but it’s not accurate. If it was already bad, it will get even worse,” he said.

STJ’s decision on health plan coverage changes will directly affect the quality of service, attorney Tatiana da Hora said.

A specialist in consumer law, professor and coordinator of the Legal Practice Center at the Tiradentes University Center (Unit-PE), he believes that there will be many losses for those who have contracts with operators.

The lawyer pointed out that it is very likely that he will have an impact on the judiciary, as there are many cases that will be taken to define what may or may not be.

“I believe that the coverage of the denied proceedings and the cases under the order will now be invalidated,” he said.

In addition, many consumers who obtained the right to court proceedings will be left without the necessary coverage, which will lead to the unification of the Integrated Health System (SUS).

“The future is still very much in doubt. The fact is that people need the help of lawyers to sign contracts with health plans, ”he added.

Tatiana is also the mother of two children with autism who also believe she may have trouble maintaining treatment.

“I think they will lose the right to treatment. The procedures that will be affected are very specific, ”he said.

The lawyer says in practice, the plan operators will overlap the profit with health problems. He says, for example, that anyone who has a problem and needs specific treatment will have to prove that there is no procedure to carry out the procedure in a verified network and try an option in court.

Health plans: what can change with the coverage of the STJ ruling

According to the STJ’s decision, health plan operators should not be required to cover procedures not listed by the National Supplemental Health Agency (ANS).

The decision includes coverage for testing, therapy, surgery, and drug supply, for example. (see video above).

Six of the nine ministers who voted in the second section have understood that the so-called list of ANS procedures is complete – that is, the list contains not only examples, but all the coverage obligations of health plans.

The decision of the STJ does not oblige the rest of the court to comply with this understanding, but the ruling serves as a matter of law for the Judiciary.

The understanding of the STJ represents a change in the jurisprudence applied by most courts in the country, as they understood that the list was just an example.

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